Heel pain and Plantar Fasciitis that won’t resolve in a reasonable time

To help you understand the treatment pathways and options for treating heel pain and plantar fasciitis, I've summarized and enhanced a recent article on heel pain that won't resolve easily.

A Guide To Conservative Care For Recalcitrant Plantar Heel Pain 2014 Podiatry Now

Recalcitrant heel pain, also known as plantar fasciitis, is a common condition that causes chronic pain beneath the heel. It often affects people who are overweight, runners, or those who stand for long periods. The pain is usually worst when taking the first steps in the morning or after periods of rest.

​The article discusses various conservative treatment options for managing this condition:

1. Stretching Exercises: Regular stretching of the calf muscles and plantar fascia can help alleviate pain.

2. Footwear Modifications: Wearing supportive shoes with proper arch support and cushioning can reduce strain on the heel.

3. Orthotics: Custom-made or customized shoe inserts can provide additional support and relieve pressure on the heel and plantar fascia.

4. Physical Therapy: A physical therapist can guide patients through exercises and techniques to improve flexibility and strength.

5. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) may help reduce pain and inflammation. A 2007 study in Foot & Ankle Int on heel pain and NSAIDs concluded "These results provide some evidence that the use of an NSAID may increase pain relief and decrease disability in patients with plantar fasciitis when used with a conservative treatment regimen"

6. Night Splints: Wearing a splint at night can keep the foot in a stretched position, reducing morning pain.

7. Shockwave Therapy: This non-invasive treatment uses sound waves to stimulate healing in the affected area.

8. Photobiomodulation Laser therapy: Is an effective method of accelerating soft tissue injuries and reducing pain. An abstract from the Journal of Foot and Ankle surgery 2019 - Photobiomodulation a Promising Therapeutic Modality in Plantar Fasciitis - says "Plantar fascia is inflammation of the connective tissues in the foot, a common cause of heel pain in adults. The currently available treatment protocols may require 6–12 months of therapy to get an individual to pain-free. Photobiomodulation (PBM) a type of laser therapy, which elicits biological changes in tissues resulting in beneficial therapeutic effects. Evidence supports the use of PBM for the degenerative conditions like tendinopathy and epicondylitis, osteoarthritis, peripheral nerve degeneration. Similarly, the use of PBM in plantar fasciitis (PF) shows a promising result."

If conservative treatments are not effective, other options like steroid injections or surgery may be considered. However, most patients find relief with the above methods.

I hope this helps! If you have any more questions or need further clarification, please feel free to ask.