When does your heel pain treatment (or heel spur treatment) need to move to the next level?
Most of us will feel significantly better very soon after we seriously begin to implement the simple home remedies that we can do or get for ourselves, like rest, icing, and wearing shoes for plantar fasciitis with some additional arch support. Many people also will use over the counter drugs, specifically anti-inflammatories, to reduce the pain when it is acute.
My doctor, and virtually every source about heel problems I’ve read, indicates that when your heel pain from plantar fasciitis is acute, anti-inflammatories like ibuprofen, naproxen or aspirin can help your symptoms. (This is despite the fact that there is a considerable amount of doubt about whether plantar fasciitis actually involves any inflammation.) As a group, these kinds of drugs are known as NSAIDs — non-steroidal anti-inflammatory drugs. Ibuprofen can be purchased as a generic or as Advil or Motrin, and naproxen is sold as Aleve. Of course you need to consult your health care provider about whether this is a good idea for you personally. Some people should not take ibuprofen, and there are a fair number of people who are concerned about its effect on your liver. I’m concerned about that, too, but I do take it, in 800mg doses prescribed by my doctor, when the pain is high, or when I have really pushed my foot too much one day and I know I’m going to feel it the next day.
Please note the following from the website of the American Academy of Family Physicians :
The use of anti-inflammatory drugs in chronic inflammatory diseases is somewhat controversial. (1,17) Eleven percent of the patients in one study (3) cited NSAIDs as the treatment that worked best for them, and 79 percent of the patients using NSAIDs were in the successfully treated group. (3) Advantages of NSAIDs are the acceptability of the use of an oral medication as a treatment modality by many patients, the convenience and ease of administration, and the acceptance by medical insurance. Disadvantages of NSAIDs are many, including the risk of gastrointestinal bleeding, gastric pain and renal damage.(18)
Farther down the road, other steps can include cortisone shots and in a few cases, surgery. Please read on as there are pros and cons for some of the options.
Many doctors and podiatrists recommend or at least offer cortisone shots to their patients with plantar fasciitis. Mine did, but I had read enough to be concerned about how helpful cortisone would really be long term and suggested to her that we wait and see if things didn’t improve with the other treatments I am suggesting in this blog, which are helping, but granted, very slowly. At this point, I don’t think I will need a shot, but am open to the possibility if things get significantly worse for any reason. One problem with these shots is that they reportedly hurt like heck, but more importantly, to me anyway, is that cortisone shots carry a decent amount of risk.
If you are considering a shot, please read Phys. Ed: Do Cortisone Shots Actually Make Things Worse? from an October 27, 2010 post on the New York Times online.
And this, again from the website of the American Academy of Family Physicians :
Corticosteroid injections, like iontophoresis, have the greatest benefit if administered early in the course of the disease but, because of the associated risks, they are usually reserved for recalcitrant cases. A plain radiograph of the foot or calcaneus should always be obtained before injecting steroids to ensure that the cause of pain is not a tumor. Steroids can be injected via plantar or medial approaches with or without ultrasound guidance. Studies (20,21) have found steroid treatments to have a success rate of 70 percent or better.
Potential risks include rupture of the plantar fascia and fat pad atrophy. (22,23) Rupture of the plantar fascia was found in almost 10 percent of patients after plantar fascia injection in one series. (22) Long-term sequelae of plantar fascia rupture were found in approximately one half of the patients with plantar fascia rupture, with longitudinal arch strain accounting for more than one half of the chronic complications. (22,23) On the other hand, one author (24) found that most individuals with rupture of the plantar fascia had resolution of symptoms with rest and rehabilitation.
The WebMD site has this to say:
Your doctor may suggest corticosteroid shots if you have tried nonsurgical treatment for several weeks without success.1 Shots can relieve pain, but the relief is often short-term. Also, the shots themselves can be painful, and repeated shots can damage the heel pad and the plantar fascia.
By all accounts, very few people need surgery for plantar fasciitis, as the great majority can resolve their problems within a year without it. If you are considering it, of course first consult your podiatrist. You might also have a look at WebMD’s feature on Plantar Fasciitis: Should I Have Surgery for Heel Pain?
- In the early stages of plantar fasciitis, talk to your doctor and/or podiatrist about the use of over the counter or prescription level anti-inflammatory drugs like ibuprofen, along with your resting, icing and stretching regimens.
- If your foot is not responding to rest, icing and anti-inflammatories in the early stages, talk to your doc about a cortisone shot. But please do your research first as this really is not for everyone.
- Consider surgery only as a last resort when all else fails.