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Heel Pain Treatment Algorithm

Heel pain, whether plantar fasciitis or plantar fasciosis, is a common foot problem that responds best to a step wise clinical protocol approach to treatment.

Plantar Fasciitis vs. Plantar Fasciosis

Plantar Fasciitis is heel pain that has been present for less than 6 months and is anacute inflammatory injury involving the plantar fascia (the ligament that holds up your arch and attaches to the heel bone). This responds well to anti-inflammatory treatments.Aggressive successful treatment of plantar fasciitis usually resolves heel pain in 6-8weeks.

Plantar Fasciosis is heel pain that has been present for more than 6 months and is characterized by a lack of inflammation and an exceptional amount of scar tissue and fibrosis. The body's response to chronic inflammation is actually to give up and decrease the healing blood supply necessary for resolution. Successful treatment of plantar fasciosis requires irritation of the tissue, break up of the scar tissue and in fact are-injury of the area so that it transforms back to plantar fasciitis. Treatment of fasciosis needs to be aggressive and resolution can take up to 4-6 months.

Conservative Treatment: Step 1 (4-6 weeks)

  • Steroid injections (no more than 3 in one year)
  • Stretching exercises
  • Shoe gear recommendations
  • Prefabricated orthotics
  • Night splint
  • Relative rest

Conservative Treatment: Step 2 (next 6-12 weeks)

  • Custom functional orthotics
  • Rest (may require a walking cast)
  • EPAT therapy (in-office procedure)
  • Physical Therapy (6-12 weeks)

Surgical Treatment: Step 3 (after 4-6 months of treatment)

  • EPF (endoscopic plantar fascial release)
  • Open plantar fascial release with heel spur resection

85% of patients get better with conservative treatment! Diligence and Consistency of treatment is the key!