The first treatment step is avoiding activities that aggravate symptoms. For example, take a few day off jogging or prolonged standing to try to rest the painful foot. Just resting usually helps eliminate the most severe pain, and will allow the inflammation to begin to settle down.
- Apply Ice Packs
Icing will help diminish some of the symptoms and control the heel pain. Icing is especially helpful after an acute exacerbation of symptoms.
- Exercises and Stretches
Exercises and stretches are designed to relax the tissues that surround the heel bone. Some simple exercises, performed in the morning and evening, often help patients feel better quickly.
- Anti-Inflammatory Medications
Anti-inflammatory medications help control pain and decrease inflammation. Over-the-counter medications are usually sufficient, but prescription options are also available.
- Shoe Inserts
Shoe inserts are often the key to successful treatment of plantar fasciitis. The shoe inserts often permit patients to continue their routine activities without pain.
- Night Splints
Night splints are worn to keep the heel stretched out when you sleep. They prevent the arch of the foot from becoming contracted at night, and is hopefully not as painful in the morning.
If the pain does not resolve, an injection of cortisone can decrease the inflammation of plantar fasciitis. However, many physicians do not like to inject cortisone around the heel because potentially serious problems can happen cortisone injections in the heel area. The two problems that cause concern are fat pad atrophy and plantar fascial rupture. Both problems occur in a small percentage of patients, but they can worsen heel pain symptoms.
A new treatment for heel spurs chronic plantar fasciitis is being investigated. This treatment, called extracorporeal shock wave therapy, or ESWT, uses energy pulses to induce microtrauma to the tissue around the heel spur. This microtrauma is thought to induce a tissue repair process by the body. ESWT is recommended in patients who have failed the previously mentioned treatments, and are considering surgical options.
After successful treatment, how can I prevent heel spur pain from coming back?
To prevent the recurrence of heel spur symptoms after treatment, proper fitting footwear is essential. Many people use shoe inserts to relieve pressure over the tender area. Custom orthotics can also be made if there appears to be a problem with the mechanical structure of the foot. It is also important to continue the stretching and exercises. These simple exercises will help maintain the flexibility of the foot and prevent the plantar fasciitis pain from returning.
What if the symptoms of the heel spur do not resolve?
In a small number of cases (usually less than 5 percent), patients may not experience relief after trying the recommendations listed above. It is important that conservative treatments (such as those listed above) be performed for AT LEAST a year before considering surgery. Time is important in curing the pain from heel spurs, and insufficient treatment before surgery may subject you to potential complications from the procedure. If these treatments fail, your doctor may consider an operation to loosen the plantar fascia, called a plantar fascia release.
Because the diagnosis of heel spurs can be confused with tarsal tunnel syndrome (as described earlier), most surgeons advocate performing a tarsal tunnel release (or at least a partial tarsal tunnel release) along with the plantar fascia release. This surgery is about 80 percent successful in relieving pain in the small group of patients who do not improve with conservative treatments.
Gill LH. "Plantar Fasciitis: Diagnosis and Conservative Management" J. Am. Acad. Ortho. Surg., Mar 1997; 5: 109 - 117.
Riddle, DL, et al. "Risk Factors for Plantar Fasciitis" J. Bone Joint Surg. Am., May 2003; 85: 872 - 877.