A Guide To Conservative Care For Heel Pain

Christopher Corwin, DPM

Keys To Reducing Inflammation

Reducing inflammation in early plantar fasciitis is also important. Short courses of NSAIDs or corticosteroids can be effective in reducing the pain associated with plantar fasciitis. These become less effective as the fasciitis lingers and may become more of a plantar fasciosis. However, they can be beneficial early on. Injectable steroids are also effective if one uses them with early plantar fasciitis. However, many patients fall into the trap of thinking that if they get the shot, then they do not have to do any of the other treatments. The injection reduces the inflammation at the fascia but does not address the cause so injections alone may lead to relapse after a short period of time. Ice or frozen water bottle massage can also help with reducing the inflammation.

   Some intense cases of plantar fasciitis or even ruptures of the plantar fascia may require either a controlled ankle motion (CAM) walker boot or cast immobilization to put the area to rest. Night splints, if patients wear them through the night and wear them appropriately, may reduce the first step out of bed pain. They also function well when the patient is lying on the couch watching television.

How Effective Is Physical Therapy In Reducing Heel Pain?

Physical therapy can be a very effective tool in the treatment of plantar fasciitis. There are many different approaches by physical therapists to the treatment of lower extremity pathologies. Even though physical therapy providers may be well respected in the treatment of knees, shoulders or hips, they may not be equally well versed in the treatment of foot or ankle pathology.

   When patients return to your office after a course of therapy, ask them exactly what they are doing in therapy. Perhaps you have sent that patient for deep tissue massage, iontophoresis, etc., and may be surprised to learn that he or she is riding the bike for 10 minutes and then stretching in the corner of the therapy gym for the remainder of the session. Patients get frustrated because these are things that they can do at the gym on their own without paying a co-pay every time.

   It is extremely important to get to know some of the physical therapists in your area and maintain a good working relationship with them. Learn what their treatment approach is to various foot and ankle problems. Are they aggressive or very conservative? How much manual therapy do they do with your patient? Do they work with athletes and more active people, or do they work with a relatively sedentary population? Are they looking above the foot and ankle for other lower limb pathology? Do not be afraid to get physical therapists on the phone and discuss the particular patient and your expectations. If they happen to call you with a question about a patient, return the call promptly. This may seem like a simple thing but it can create a lot of goodwill with that physical therapist.

   After creating this relationship with therapists, do not be surprised if they start sending you patients. Mrs. Jones may be doing physical therapy as part of her rehabilitation after a total hip replacement and may develop a compensatory plantar fasciitis due to gait dysfunction. After she mentions this to her therapist, you suddenly get a referral for heel pain. From a practice management standpoint, this can be very lucrative.

   Why are we adding physical therapy into the treatment arsenal? The goal of physical therapy is to restore normal soft tissue mobility, restore normal joint mobility and correct dysfunctional lower extremity mechanics.

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