Heel Pain

Reducing Pressure on the Heel. Several approaches can relieve pressure on the heel, including:

• Sturdy Shoes and Insoles. It is important to wear comfortable but sturdy shoes that have thick soles, rubber heels, and a sole insole to relieve pressure. (An insole with an arch support might also be helpful.) Cutting a round hole about the size of a quarter in the sole cushion under the painful area may help support the rest of the heel while relieving pressure on the painful spot itself. Heel cups are not very useful. When combined with exercises that stretch the arch and heel cord, over-the-counter insoles may offer the same relief as prescribed orthotics. A 2001 study indicated, however, that patients may comply better with custom-made orthotics.
• Night Splints. Some evidence suggests that splints worn at night may be helpful for some people. One device, for example, uses an Ace bandage and an L-shaped fiberglass splint to keep the foot stretched while the patient is sleeping. This allows the muscle to heal. One study reported that nearly any splint, regardless of cost, is equally effective in about three-quarters of patients. Although patient compliance may be better with custom-made prescribed orthotics than with tension night splints, one study has found they are equally effective in improving pain.
• Elevated Heels. Some people report that mild symptoms may be relieved with the use of shoes or cowboy boots that have elevated heels. This approach, however, may not work in some people and is not recommended for anyone with a moderate to severe condition. (Heel cups have not been proven to be very useful.)

Extracorporeal Shock Wave Therapy. In 2002, the FDA approved extracorporeal shock wave therapy (ESWT) for treatment of plantar fasciitis. ESWT is increasingly being used as an alternative to surgery for patients who have not responded to other treatments. The therapy uses low-dose sound waves to injure the surrounding tissues in the heel, which triggers healing of the tissues that are causing the pain. ESWT is performed at an outpatient surgical facility and involves local anesthesia and conscious sedation. Several long-term studies have shown benefits lasting a year or more, although other short-term studies have suggested that the treatment is ineffective. Results are not usually seen until at least 3 months after treatment.