Not all heel pain will resolve using a conservative home-treatment approach. In a clinical setting we find runners will approach us after weeks, if not months, of trying multiple treatments at home. By this point, most heel pain injuries can be classified as chronic (i.e not healing on its own)..
I will outline the treatment pathways for heel pain that you can access in a clinical setting below. These are also options that I’ve taken up during my own heel pain journey.
Heel Pain Treatment Pathway 6: Cortisone Injection
My treatment pathway was not all sunshine and rainbows. Despite all the exercises and conservative approach I took, my heel pain was not abating. The pain affected my ability to enjoy even short walks with my family. It was at this point that I decided to have a cortisone injection.
Cortisone is a man-made hormone given to reduce inflammation. Research has found that cortisone can effectively reduce heel pain for 4 weeks if combined with a good rehabilitation program to maintain strength in the plantar fascia. This is important because cortisone injections can also weaken the plantar fascia, putting it at an increased risk of rupture (tear).
The absence of pain after a cortisone injection can lead runners to have a false sense of security. This is very dangerous in that runners may think their injury is ‘cured’ so doing any running that is more than what the plantar fascia can bear after a cortisone injection can lead to an increased risk of rupture and further damage to the tissue.
Continuing the plantar fascia rehab exercises and running for short periods on softer surfaces is the best way to keep your injury in check.
Heel Pain Treatment Pathway 7: Custom Orthotics
Foot orthoses are shoe inserts designed to support, align and improve the function of the foot. They are also often commonly referred to as ‘orthotics’.
For heel pain, the goal is to reduce the load and strain on the plantar fascia when you weight bear so that it can heal. You will be recommended that orthotics will be the best option for you after a gait analysis whereby the Podiatrist assesses your walking/running posture from the feet up.
For runners with heel pain that have never worn orthotics for running before, I usually recommend that they not run with orthotics but rather have them for times when out walking or standing. With the right advice and treatment plan that encompasses a plantar fascia rehab program, the addition of orthotics to the treatment program can help runners get to their ‘pain-free’ goal alot sooner.
During my heel pain journey my custom orthotics definitely helped me get through the day with a lot less pain. When I run I do not wear them. They live in my work shoes and my walking shoes only.
Heel Pain Treatment Pathway 8: Shockwave Therapy
Shockwave therapy (ESWT) is a progressive treatment option used to help with chronic conditions which affect all parts of the body. Radial shockwaves are high-energy acoustic waves passed on from a handpiece held against the skin and dissipated outwards to painful spots into the underlying tissues. The energy promotes regeneration and reparative processes of the bones, tendons and other soft tissue.
If your heel pain injury has been present for longer than 2-3 months shockwave therapy will be an excellent option.
I was in a fortunate position where I could access this type of treatment from the start. My shockwave treatments were once per week for roughly 6-8 treatments in total.
Heel Pain Treatment Pathway 9: Dry Needling
Dry needling has been around for centuries. It is a form of treatment that uses a “dry” sterile needle, one without medication or injection, inserted through the skin into areas of overworked muscle, known as trigger points. Reducing the tightness in these trigger points often reduces pain and restores proper soft tissue function.
At this point we must stress that Dry Needling is different to Acupuncture. Dry needling attempts to release tension from knots and pressure points in muscles whereas acupuncture aims to release endorphins and aims to affect the nervous system.
When it comes to heel pain, our Podiatrists will look to see if there are any trigger points in the leg or foot that will need to be released. In many cases, improved mobility is immediate and decreased pain is felt within 24 hours. Typically, it may take a few treatment sessions (once a week for 2-3 weeks) for a lasting positive effect.
Heel Pain Treatment Pathway 10: Foot Mobilisation Therapy (FMT)
Foot Mobilisation Therapy (FMT) is a ‘hands on’ therapy utilising unique mobilisation and manipulation techniques to treat many biomechanical and foot alignment issues, targeting stiff joints.
There may be some malalignments in your foot that could be the underlying cause of your heel pain.
FMT works on the principle that joints and tissues work best when they’re in the ‘right place’. It works by improving the mobility and congruency of joints in the feet, which in turn allows muscles to work more efficiently around those joints. This establishes better movement pathways and can relieve pain.
My heel pain journey didn’t involve using FMT or Dry Needling, however I have used those techniques on many runners with the same injury and have found them to work relatively well.
Heel pain injuries tops the list for being the most talked about injury in runners. Why? Because the pathway to getting the pain to resolve is so varied and not everyone’s journey will be the same. I have found that my heel pain injury was a blessing in disguise as I was forced to walk in the shoes of those that I treat.
I left no stones unturned, I tried everything! I took calculated risks just to see if there was a better way to get back to running quicker. I’ve learnt that heel pain treatment doesn’t follow a one directional journey, it will have its ups and downs, it will require the use of multiple treatment options being applied at the same time to get the best result.