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Pleasanton 830-569-FEET (3338)
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Next Step Foot & Ankle Clinic

How to Treat Chronic Heel Pain

“Hi, this is Dr. Silvester, and I’m going to talk to you a little bit about one of the most common things we see in our office, and that’s heel pain, or plantar fasciitis, and try to give you some idea of what we can do for you if you have that condition, how we treat it, and what the goals of the therapy are. Hopefully, we’ll also give you some idea as to how you can also take care of it a little bit yourself.

First of all, plantar fasciitis occurs on the heel – usually on the inside of the heel, on the bottom. It occurs mostly in the morning, when you first get up. Patients will come in and they’ll say, “Gee, when I first get out of bed, those first four or five steps are miserable! Then after that it loosens up a little bit, feels okay for a while, and then maybe by the end of the day it starts hurting again.”

That’s pretty typical for plantar fasciitis. The critical thing, when you have heel pain, is to make sure you’re treating the right condition. We just had a lady who had come in from another doctor’s office and she had been receiving injections in her heel and she really wasn’t getting anywhere, so as a result, she decided to come to see us. We diagnosed her as having a nerve component to her pain and so I gave her some injections in the nerve areas, not down in the plantar aspect of the heel, and she experienced significant relief. The right diagnosis is critical for treatment.

For the vast majority of people with heel pain, it’s pretty simple. They have pain on the bottom of their foot. What we do, generally, is address the inflammatory component and we usually give a steroid injection, initially. The reason I do that is because I don’t like to waste my patients’ time and if they come to see me, by the time they’re seeing me, they are usually tired of the heel pain and they want to get over it, so we give them a steroid shot, because that’s one of the most effective short term therapies for heel pain available.

The second thing we do, is we give them an arch support – that addresses the cause. The way their foot functions – that will help align the foot so that the ligament on the bottom of the heel doesn’t have to take so much stress and so much tension. The third thing we do is we give them some physical therapy, which consists of stretching exercises and ice. If they’ll do that, most of the time, about 70-80% of people will get rid of the majority of their heel pain in a very short period of time. So what will happen is in one visit, usually by the second visit, the patient is much more comfortable.

Some people don’t fit that criteria – they have more severe symptoms and they need further treatments and we have a step-wise ladder of protocols to address those problems.

Things that we do that’s different from other clinics:

If the heel pain doesn’t resolve initially, we have a modality that we use called “Cryosurgery”, where we freeze the plantar fascia. We have radio wave surgery that we can do that’s all done through a pinpoint/needlepoint procedure and that’s proven very effective for treating plantar fascia inflammation. There are also some other modalities that we are obtaining in our office, like shockwave therapy.

Regardless, we handle a spectrum of surgical treatments, if that’s needed. Most patients don’t get to that stage, though. The vast majority of people will get better with just conservative care, treating their plantar fasciitis. So, if you have heel pain, give us a call, we’d love to help you out with that. We feel like we’re one of the best places in south Texas, where you can get rid of that in a very quick fashion and usually without having to spend a great deal of money. Thank you very much.”