Current Insights On Conservative Care For Heel Pain

Start Page: 36

Keys To Ensuring A Good Fit With Athletic Shoes

• Measure both feet standing on a Brannock device.
• Have patients try on shoes in the afternoon or evening due to swelling.
• Have patients wear similar weight socks or orthotics for activity.
• Have patients try on shoes a half size larger to compare fit.
• Do the basic three shoe tests to evaluate quality.
• Tell patients there should be at least one finger width from the end of the longest toe to the end of the shoe.
• Have patients wear new shoes indoors first to make sure they are comfortable.
• The shoe should not require a break-in period.
• Educate patients on knowing when to replace shoes and the differences among shoe brands.

42
Author(s): 
Tim Dutra, DPM, MS

   There is also quite a bit of controversy over the value of stretching so the jury is still out. However, I tend to be a believer in the benefit of stretching both in recovering from an injury as well as helping to prevent injuries. When addressing stretching, one should specifically focus on stretching the calf muscles as well as the plantar fascia for both sides. It should be a gradual approach with slow, long, static stretching that builds up gradually over time as the patient can tolerate. One should avoid rapid, violent stretching (ballistic). I will usually recommend a pre-activity stretch after a brief warm-up and a post-activity stretch after cooling down.

How Cross Training Can Keep Heel Pain Patients Active

Cross training is a very important aspect of the treatment plan. It is important that patients are able to keep up their level of fitness while recovering from heel pain. Ideally, you can have them use pool therapy, bike or elliptical training to stay in shape and avoid stressing their foot.

   Limiting or restricting activity is often difficult, especially for the athlete. One should address the intensity and frequency of activity, especially when it comes to those participating in youth sports. Fortunately, children are often involved in varied activities anyway so cross training is helpful in the treatment plan for youth injuries. Cross training is an essential part of the treatment plan for dealing with high school, college and professional athletes.

   It is important to realize that exercise prescription is a major part of dealing with the treatment of heel pain. Prescribing exercise and tailoring it to a specific patient is a talent you should develop. Proper exercise prescription can greatly assist in motivating patients to be actively involved in the treatment and help ensure that their fitness level does not drop off significantly. Improper exercise can prolong the recovery time and increase the rehabilitation period. Return to activity guidelines should be clear to the patient with reasonable goals and expectations.

Pertinent Tips For Performing Corticosteroid Injections

Corticosteroid injections can be helpful as part of the treatment plan you offer to the patient. I tell the patient the injection can help with the pain and inflammation. This can also be a good alternative for a patient who cannot take NSAIDs.

   I inject at the medial aspect at the transition area of the dorsal to plantar skin. This approach can avoid the fat pad inferiorly and the calcaneus superiorly.

   I always offer ethyl chloride to help minimize the pain. I penetrate the skin quickly and then slowly inject the heel. It is important to explain to patients that they will feel the cold spray, then a stick and a little burning or discomfort. I will usually inject dexamethasone phosphate or Kenalog (Bristol-Myers Squibb) with bupivacaine. I will do up to three injections depending on how the patient responds to the initial injection but usually one or two injections is sufficient to calm down the heel pain.

   I stress that a corticosteroid injection is not a cure, just part of the treatment plan. If the patient does not respond to the injection series, I would consider an oral corticosteroid, such as a Medrol dosing pack. It is pointless to repeat steroid injections when there is little or no response in reducing symptoms. I typically do not offer cortisone injections in the acute phase. Also, I warn the patient of a possible steroid flare-up following the injection, which usually resolves in a short period of time. Be sure to caution the patient to reduce activity following a corticosteroid injection as it can mask the pain during activity and make the condition worse.

image description image description


Anonymoussays: November 8, 2010 at 6:44 am

All interested might want to check out a systematic review by van de Water et al. (published earlier this year) about the effects of taping on plantar fasciosis.

Reply to this comment »

Post new comment

  • Web page addresses and e-mail addresses turn into links automatically.
  • Lines and paragraphs break automatically.

More information about formatting options

Image CAPTCHA
Enter the characters shown in the image.