The San Antonio Orthopedic Group

Marvin R. Brown, M.D., P.A.

(210) 593-1400 phone

(210) 615-1634 fax

HEEL PAIN SYNDROME

You have been diagnosed with heel pain syndrome. This is an inflammation of a ligament on the bottom of your foot called the “plantar fascia.” Conservative treatments are usually sufficient in treating heel pain syndrome. These treatments include all of the following:

  1. Anti-inflammatory medications such as Voltaren, Naprosyn, Indocin, Motrin, Celebrex, Vioxx, Daypro, etc. These medications should always be taken with food. Please refer to your prescription for how often and how much you are to take. If this medication irritates your stomach, please stop the medication and notify the office.
  1. Heels cups are to be warn in your shoes. These should be obtained at the time of your office visit as there are many and varied heel cups, some of which may actually increase your symptoms. The heel cups are transferred to whichever pair of shoes you are wearing that particular day. Please be sure to wear one heel cup in each shoe to avoid low back problems. Some patients may require fabrication of orthotics.
  1. Stretching exercises for your heel cords (Achilles tendon) and plantar fascia are important to warm up the affected area and decrease discomfort. These should be done for two minutes at a time, per exercise, and at least five times a day. A routine should be developed of stretching the first thing in the morning when you wake up, mid-day, evening, meals, and at bedtime to be effective. Please see the attached sheet for the exercises.
  1. Weight loss is also an important aspect of conservative treatments due to the excessive force that extra weight places on the feet. There are several good weight loss programs available. Most of the patients who lose large amounts of weight do so with a program. You may consult your family doctor or internist.
  1. Shoes: wear roomy, supportive shoes with excellent cushion. Recommendations include SAS “Free Time” and “Time Out” shoes, Rockport Prowalkers, New Balance “Cross Trainers” #608, leather clogs (Clark, Simple, Born, etc.)
  1. On return to the office, a steroid injection may be placed in the area of discomfort in the heel if you have not improved. The steroid that is used does not cause side effects such as “buffalo hump”, water weight gain, mood changes, increased muscle mass, or hair growth. It is locally absorbed and works to decrease the inflammation around the inflamed fascia. This medication continues to work for approximately six weeks, and then you are re-evaluated. You may initially experience an increase in discomfort the first day or two following the injection. This is called a “steroid flare” and should be treated by elevating you foot and placing an ice pack on the painful area of your heel. You may also use Aspirin, Advil, or Extra-Strength Tylenol for the discomfort. The steroid injections may be given an additional two times per year, six weeks apart. With the third injection, a cast is applied for three weeks. If the cast is successful in relieving the pain, a night-time AFO brace will be ordered.
  1. The use of a night-time AFO brace is frequently helpful in decreasing the pain and inflammation in your heels. The AFO may also be beneficial in improving the results from your stretching program. The braces are to be worn at night only. The first couple of nights you may have trouble adjusting to sleeping with the braces. Most patients find that this goes away after two or three nights of use.
  1. After 9 to 12 months, if all conservative measures fail, surgery may be recommended.

Please feel free to contact the office at (210) 593-1400 if you have any problems.

Marvin R. Brown, M.D., P.A.

HEEL CORD STRETCHES

  • Purpose: To stretch and warm up the heel cord and plantar fascia.
  • Starting Position: Standing with your hands on a solid object for support and your right leg about one foot behind you. Point the toes of your right leg forward with your knee straight. Place the left foot about one foot in front of you, also keeping the toes pointed straight ahead, but with your left knee bent.
  • Action:
  1. With your right leg and keeping the heel flat on the floor and the right knee straight, gradually lean forward, feeling the stretch in your right calf.
  1. Repeat with the opposite leg.