Current Insights On Conservative Care For Heel Pain

A Two-Pronged Approach to Treatment
To develop an effective treatment plan, one should consider using what I refer to as a “two pronged” treatment approach for the patient. This approach considers treating the symptoms and treating the cause. Treating the symptoms of pain and inflammation would include any combination of: nonsteroidal anti-inflammatory drugs (NSAIDs); cortisone injection; physical therapy; or cryotherapy. Treating the cause would include any combination of: taping; orthotics; shoe recommendations or modifications; night splints; cross training; and/or modification or restriction of activity.

Too often, a treatment plan will address only one of these areas. For example, the patient receives an injection, which does nothing to address the cause of the heel pain.

I have found taping to be a valuable tool in treating heel pain but it appears to be a lost art. Taping can be therapeutic as well as diagnostic in determining if a patient could benefit from functional orthotics. I like to say, “Orthotics are only as good as the shoes that you put them in.” If shoes are worn out or not recommended for your patient, orthotics will not be as effective in controlling the foot.
The biomechanical exam and gait evaluation are critical to addressing the underlying cause. You need to determine what diagnostic studies are needed to confirm your diagnosis, especially if it does not appear to be your classic plantar fasciitis injury.

Is Stretching Beneficial For Patients With Heel Pain?
To stretch or not to stretch — that is the question. All too often we will recommend stretching to patients for treating heel pain in the acute phase of the injury. Unfortunately, stretching often starts before the area has healed sufficiently. Stretching should not begin until the rehabilitation phase of the injury, after the healing phase has occurred. If stretching starts too early, it creates a vicious cycle and can prolong the healing of the injury.
There is also quite a bit of controversy over the value of stretching so the jury is still out. However, I tend to be a believer in the benefit of stretching both in recovering from an injury as well as helping to prevent injuries. When addressing stretching, one should specifically focus on stretching the calf muscles as well as the plantar fascia for both sides. It should be a gradual approach with slow, long, static stretching that builds up gradually over time as the patient can tolerate. One should avoid rapid, violent stretching (ballistic). I will usually recommend a pre-activity stretch after a brief warm-up and a post-activity stretch after cooling down.

How Cross Training Can Keep Heel Pain Patients Active
Cross training is a very important aspect of the treatment plan. It is important that patients are able to keep up their level of fitness while recovering from heel pain. Ideally, you can have them use pool therapy, bike or elliptical training to stay in shape and avoid stressing their foot.

Limiting or restricting activity is often difficult, especially for the athlete. One should address the intensity and frequency of activity, especially when it comes to those participating in youth sports. Fortunately, children are often involved in varied activities anyway so cross training is helpful in the treatment plan for youth injuries. Cross training is an essential part of the treatment plan for dealing with high school, college and professional athletes.
It is important to realize that exercise prescription is a major part of dealing with the treatment of heel pain. Prescribing exercise and tailoring it to a specific patient is a talent you should develop. Proper exercise prescription can greatly assist in motivating patients to be actively involved in the treatment and help ensure that their fitness level does not drop off significantly. Improper exercise can prolong the recovery time and increase the rehabilitation period. Return to activity guidelines should be clear to the patient with reasonable goals and expectations.