No Need to Be Down on Your Heels

At one time or another, most people experience chronic heel pain. It’s especially prevalent in city dwellers who pound the pavement every day, getting themselves to and from work. Or in those physically active folks, you know, the runners, dancers and gym enthusiasts. Another group at risk are individuals who are on their feet all day, like teachers, medical care providers and first responders.

Before we delve into what these nice people need to know about treating their heel discomfort, I need to distinguish them from those who have experienced trauma. When significant heel pain occurs due to an accident or fall, we can fairly easily and effectively diagnose it with an X-Ray or in office ultrasound. Then we can treat it with appropriate offloading, or diverting pressure away from the injury, and, depending on its severity, treat as appropriate. I therefore always urge these folks to visit an urgent care / ER or their clinician immediately.

If you find, however, that your heel pain has been occurring with a gradual soreness over time, then I recommend a more thorough evaluation. I promise, no medical terminology! Whether your discomfort is at the bottom or rear of the heel, all you need to know is that there’s something wrong happening and it’s normally caused by overuse, a change in shoes or perhaps a new activity. If any of this sounds like you, then please don’t ignore it. Left alone, tissue damage can start – an unfortunate cycle of breakdown, scarring, breakdown, scarring – and it will creep up on you in the form of chronic pain.

Now, to more positive news. I’ve had much success with a plan of action that occurs in a stepwise manner, if you’ll excuse the pun. So, let’s move conservatively at first. I generally stay away from cortisone shots because frankly, although they may reduce pain short term, they’re just a bandaid and have the potential to degrade rather than rebuild injured tissue. Instead, I’d go with a round of anti-inflammatory medication along with bracing or strapping to stabilize the foot, and athletic taping to prevent further damage. I’d also recommend modified or reduction in specific activities that may prevent healing .

Keep in mind, however, that we’ll set a thorough but short time limit to monitor improvement with this conservative type of care. I’ve seen all too many people doing the same thing for weeks and weeks without improvement. So, if we’ve brought your pain down to an acceptable level after a relatively short period of time, we’ll continue to monitor and evaluate. If not, then we’ll move on to the second step.

Here’s where we’ll get more aggressive with high resolution imaging – MRI, CT, Ultrasound– to help us obtain a clearer picture of what is going on. Once diagnosed properly, we’ll get you back on your feet with a long-term solution. Perhaps treatment for minor tears and the like will require minimally invasive procedures. However, over the past few years advanced studies now also allow us to use Regenerative Medicine to literally rebuild and strengthen injured soft tissue. Pretty exciting stuff!

So how does that work? Well, without over complicating things, with the help of Rejuvenation Therapy Injections, we in effect harvest a portion of the body’s regenerative capability (almost like donating blood) to hasten and aid its ability to heal itself. We may also opt to use Extracorporeal Shock Wave, which in effect induces a chronic injury to become a fresh injury again. Then we give the body the regenerative capability to fix it. Of course, we’re not talking a cure-all, but regenerative techniques are indeed minimally invasive and allow a faster return to activity by avoiding traditional open surgery.

The final steps in treatment always involves aggressive physical therapy. I’m not talking about the run of the mill massage and ultrasound, but customized therapy that targets your usual activities be it dancing, running or a busy lifestyle commuting on the streets of New York! Like shoes, when it comes to PT, one size doesn’t fit all.

I highly recommend this systematic, stepwise approach to anyone experiencing debilitating heel pain. If you stick to the program, you’ll be kicking up your heals in no time!

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