Most people start with a visit to the local doctor who will usually refer for an x-ray. Heel Spurs are sometimes present but these are irrelevant, as Heel spurs do not usually cause pain. Hence, heel spur treatment might not be relevant. Treatment should be directed at the soft tissue such as the Plantar Fascia or the Achilles Tendon / Bursa (Depending on your condition)
PHYSIOTHERAPY / MASSAGE
In the early stages of Plantar Fasciitis and Achilles Tendon pain, massage therapy and stretching the calf muscles can be helpful. However, patients with a more chronic condition might not respond to treatment. Sometimes there will be a slight reduction in pain, but this can be short lived. Some patients are unable to perform foot stretches as these increase the pain in the heel.
Attempting to stretch the plantar fascia can give short-term relief but can prolong the condition. Stretching the calves can also relieve the Achilles Tendon but this is not usually enough to treat it thoroughly. The fascia is not like muscle, or tendon, therefore it is not flexible. The most commonly advised foot and ankle exercises usually increase the pull of the fascia on the heel bone and hence can aggravate it. Calf stretches, step stretches,, heel raises and pulling the toes back can therefore prolong the condition.
Most patients stop exercising for a while and find some improvement only to find that the pain returns when they start again. Consequently, some patients start to put on weight due to inactivity and this adds load to the plantar fascia or Achilles. This is a catch 22 situation, and proper intervention to support the foot is essential. Resting is not a valid treatment.
ICE PACKS / HEAT PACKS
Ice packs reduce inflammation and can help with pain but don’t address the underlying load issue on the Achilles tendon or Plantar Fascia. Hence patients usually report nothing more than short-term relief. Although heat packs feel good against the heel, they can increase inflammation. Again, patients usually feel no long-term improvement.
HEEL CUSIONS / ARCH SUPPORTS / GEL PADS
These can feel good for a short while as they are soft against the painful heel. However, they compress quickly and after a week or 2 they can become less helpful. Some patients report an increase in pain with gel heel cups due to the instability they cause.
ROLLING THE FOOT OVER A TENNIS BALL / GOLF BALL/ FROZEN WATER BOTTLE ETC
This form of massage should be avoided as there is a tendency for the patients to allow too much foot pressure against the hard object, which applies too much pressure on the plantar fascia.
A symptomatic treatment that can reduce pain. This doesn’t address the underlying need to support the plantar fascia.
As a stand alone treatment, injection therapy can help with pain. Often, the pain returns once the cortisone has worn off. After trying many different remedies and believing that there are no other treatment options available some patients return to their doctor in search of an answer. By this stage, patients are usually feeling desperate and will try anything and their GP will either give an injection of cortisone or refer to an orthopaedic specialist who will do the same.
Most orthopaedic specialists these days will probably advise against having an operation for Plantar Fasciitis due to the very low success rate.