Your treatment plan
Treatment for heel pain usually involves trying a combination of techniques, such as painkillers and exercise, to relieve pain and speed up your recovery time.
Surgery is usually regarded as a ‘treatment of last resort’ if your symptoms fail to improve after 12 months. Only 1 in 20 people will need surgery.
Rest
Rest the affected foot whenever possible by avoiding standing for long periods of time or walking long distances. However, it is important to regularly exercise your feet and calves with stretching exercises. See below for more information.
Pain relief
Non-steroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen, are a type of painkilling medication that are usually effective in helping to relieve pain.
Some people also find that applying an ice pack to the affected heel for 5 to 10 minutes can help to relieve pain and inflammation. Ice packs are available from larger pharmacies and supermarkets.
Do not apply the ice pack directly to the skin because this can damage it. Instead, wrap the ice pack in a towel. If you do not have an ice pack, use a packet of frozen vegetables.
Exercise
Regular exercises designed to stretch both your calf muscles and your plantar fascia (band of tissue that runs under the sole of the foot) should help relieve pain and improve flexibility in the affected foot.
A number of stretching exercises are described below. It is usually recommended that you do the exercises on both legs, even if only one of your heels is affected by pain. This will improve your balance and stability, as well as helping to relieve heel pain.
Towel stretches
Keep a long towel beside your bed. Before you get out of bed in the morning, loop the towel around your foot and use the towel to pull your toes towards your body while keeping your knees straight. Repeat three times for each of your feet.
Wall stretches
Place both of your hands on a wall at shoulder height with one of your feet in front of the other. The front foot should be 30cm (12 inches) away from the wall. With your front knee bent and your back knee straight, lean towards the wall until you feel a tightening in the calf muscles in your back leg. Then relax. Repeat this procedure 10 times, then switch legs and repeat the cycle. It is recommended that you carry out wall stretches twice a day.
Stair stretches
Stand on your stairs facing upstairs while using your banister for support. Your feet should be slightly apart and your heels should be hanging off the back of the stair. Lower your heels until you feel a tightening in your calves. Hold this position for around 40 seconds, then raise your heels back to normal. Repeat this procedure six times, at least twice a day.
Chair stretches
Sit on a chair with your knees bent at right angles so that your feet are pointing in opposite directions. Lift the affected foot upwards while keeping the heel on the floor. You should then feel your calf muscles and Achilles tendon (band of tissue that connects the heel bone to the calf muscle) tighten. Hold this position for several seconds, then relax. Repeat this procedure 10 times, five or six times a day.
Dynamic stretches
While seated, roll the arch of your foot (the curved bottom part of the foot between your toes and your heel) over a round object, such as a rolling pin, tennis ball or drink can (some people find that using a chilled can from their fridge has the added benefit of helping to relieve pain). Move your foot and ankle in all directions over the object. Continue the exercise for several minutes and repeat the exercise twice a day.
Shoe wear
Depending on your usual choice of footwear, your GP or podiatrist (a healthcare professional who specialises in foot care) may advise you to change your footwear. Avoid wearing flat-soled shoes as these will provide no support to your heel and could make pain worse.
Ideally, you should be wearing shoes that provide good support to the arches of your feet while cushioning your heels, such as laced-up sport shoes.
For women, wearing high heels and, for men, wearing high-heeled boots or brogues can provide short- to moderate-term relief of pain, as they help reduce the pressure on the heel. But these types of footwear may not be suitable in the long-term, as they can lead to further episodes of heel pain. Your GP or podiatrist should be able to advise you.
Orthoses
Orthoses are in-soles that fit inside your shoe to support your foot and assist the healing of your heel. You can buy orthoses off the shelf at larger pharmacies or sports shops, or your podiatrist should be able to recommend a supplier.
If your pain keeps reoccurring, does not respond to simple treatment measures, or you have an abnormal foot shape or structure, custom-made orthoses are available. They are specifically made to fit the shape of your feet.
However, there is currently no evidence that the custom-made orthoses are more effective than those bought off the shelf.
Strapping and splinting
An alternative to using orthoses is to have your heel strapped with sports strapping (zinc oxide) tape. The strapping will help to relieve pressure on your heel.
Your GP or podiatrist should be able to teach you how to apply the straps yourself.
Night splints can also be useful in some cases. Most people sleep with their toes pointing down, which means that the tissue inside the heel is squeezed together.
Night splints, which look like a type of boot, are designed to keep the toes and feet pointing up during sleep. This will stretch both the Achilles tendon and your plantar fascia while you sleep, which should help speed up your recovery time.
Night splints are usually only available from specialist shops and online retailers. Again, your podiatrist should be able to recommend a supplier.
Corticosteroid injections
If none of the treatments above help to relieve your pain symptoms, your GP may recommend that you have an injection of corticosteroids.
Corticosteroids are a type of medication that have a powerful anti-inflammatory effect. They have to be used sparingly because overuse can cause serious side effects, such as weight gain and high blood pressure (hypertension).
As a result of this, it is not usually recommended that more than three corticosteroid injections are given within a year in any part of the body.
Before having a corticosteroids injection, a local anaesthetic (painkilling medication) may be used to numb your foot so that the injection is not painful.
Surgery
If all the treatments listed above and corticosteroid injections do not relieve your heel pain, your GP may refer you to either:
- an orthopaedic surgeon – a surgeon who specialises in surgery that involves the bones, muscles and joints
- a podiatric surgeon – a podiatrist who specialises in foot surgery
Surgery is sometimes recommended for professional athletes and other sportspeople whose heel pain is negatively affecting their career.
Plantar release surgery
The most widely used type of surgery for heel pain is known as plantar release surgery. This is when the surgeon cuts the fascia to release it from the heel bone. This should reduce tension in your plantar fascia, which in turn should reduce inflammation and relieve your pain symptoms.
There are two ways that the surgery can be performed:
- open surgery – the section of the plantar fascia is released by making a cut into your heel
- endoscopic/minimal incision surgery – a smaller incision is made and special instruments are inserted through the incision to gain access to the plantar fascia
Endoscopic/minimal incision surgery has a quicker recovery time so you will be able to walk normally much sooner (almost immediately) compared with two to three weeks for open surgery.
A practical disadvantage of endoscopic surgery is that it requires both a specially trained surgical team and specialised equipment, so you may have to wait longer for treatment than if you choose open surgery.
Endoscopic surgery also carries a higher risk of damaging nearby nerves, which could result in symptoms such as numbness, tingling or some loss of movement in the foot.
You should discuss the pros and cons of both approaches with your surgical team.
The results of both surgical techniques have been mixed. As a result, they are rarely performed.
As with all surgery, plantar release carries the risk of causing complications, such as:
- infection after surgery
- nerve damage
- symptoms getting worse after surgery – although this is rare
Extracorporeal shockwave therapy (EST)
A new type of non-invasive treatment (does not involve making any cuts in your body) is known as extracorporeal shockwave therapy (EST).
EST involves using a device to deliver high-energy sound waves into your heel. These waves can sometimes cause pain, so a local anaesthetic may be used to numb your heel.
It has been claimed that EST works in two ways:
- the sound waves have a ‘numbing’ effect on the nerves that transmit signals of pain to the brain
- the sound waves help stimulate and speed up the healing process
Neither claim has yet been definitely proven.
In 2009, the National Institute of Health and Clinical Excellence (NICE) issued guidance about EST.
NICE reported that it believed the procedure was safe, but there were uncertainties about how effective EST was in the treatment of pain. Some studies had reported that EST was superior to both traditional surgery and non-surgical treatments, while other studies found that EST was no better than placebo (sham treatment).
If you are considering EST, it is important that you understand the real uncertainties that surround EST. It is possible that EST works well for some people but has no effect on others.
