Surgery. Surgery is appropriate in about 5% of patients, typically those who have disabling heel pain for at least a year that does not respond to other treatments. A typical surgery is called instep plantar fasciotomy. It relieves pressure on the nerves that are causing pain by removing and therefore releasing part of the plantar fascia.
The standard procedure uses a large incision and takes about 2 months to resume complete normal activity. A less invasive variant uses a procedure called endoscopy that employs small incisions and is proving to be effective.
For either approach, some studies report good to excellent pain relief in 80 - 90% of patients. In one study, however, half of the patients were dissatisfied because the procedure didn't work or because recovery took too long. In another 2000 study, about 15% of the patients reported long-lasting complications, including pain from scar tissue and continued heel pain. Pain is more likely when more than half of the plantar fascia was released during surgery.
Wearing a below-the-knee walking cast after the operation for two weeks may reduce the need for pain relief and speed recovery time compared to use of crutches.
Botox. Research shows that injections of botulinum toxin (Botox), a protein used to temporarily paralyze certain muscles, reduces pain and improves patient's ability to walk.
Bursitis of the Heel
Bursitis of the heel is an inflammation of the bursa, a small sack of fluid, beneath the heel bone. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil) and steroid injections will help relieve pain from bursitis. Applying ice and massaging the heel are also beneficial. A heel cup or soft padding in the heel of the shoe reduces direct impact when walking.
Haglund's Deformity
Haglund's deformity, known medically as posterior calcaneal exostosis, is a bony growth surrounded by tender tissue on the back of the heel bone. It develops when the back of the shoe repeatedly rubs against the back of the heel, aggravating the tissue and the underlying bone. It is commonly called pump bump because it frequently occurs with high heels. (It can also develop in runners, however.)
Treatment for Haglund's Deformity. Applying ice followed by moist heat will help ease discomfort from a pump bump. Nonsteroidal anti-inflammatory drugs (NSAIDs) such as aspirin or ibuprofen (Advil) will also reduce pain. Your doctor may recommend an orthotic device to control heel motion. Corticosteroid injections are not recommended because they can weaken the Achilles tendon.
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