What to Do for Throbbing Heel Pain
Does your heel hurt the first step you take in the morning or the first step from sitting? If so, then you most likely have a condition known as plantar fasciitis, also known as Heel Spur Syndrome. The condition develops one day after an innocuous overuse injury. The tissue partially tears and then partially heals overnight. As you take your first step in the morning, you tear all the healing from the night before. The heel can’t heal as you walk on it all day long and the same thing happens day after day after day. Given enough rest, the condition will resolve and 90% of people get better.
Nonsurgical treatments are plentiful but most only help to improve symptoms while the body heals itself. Some nonsurgical treatments include:
- A “Dorsiflexion Night Splint”
- Stretching Exercises of the Calf and Plantar Fascia Tissue
- Strengthening Exercises to Plantar Intrinsic Musculature
- Heel Cups
- NSAIDs such as Ibuprofen and Naprosyn
- Weight Loss
Temporary accommodation lets the tissue heel but sometimes leads to other problems. Occasionally, symptoms don’t resolve and instead worsen at the end of each day. People remove their shoes, rub, ice, and heat massage the heels to relieve the throbbing heel pain. Despite not walking, the pain persists several hours after sitting down. At this point the condition involves nerve entrapment.
The first branch of the lateral plantar nerve, which supplies the muscles that spread the little toe outward, is stuck in thickened fascial scar. Injections of cortisone around those nerves, but not into the plantar fascial tissue, will provide temporary and sometimes permanent relief.
Plantar Fasciitis Injections & Surgery
Injections into the plantar fascia itself will cause further tearing of the tissue. This is not a recommended method of treatment. It is very painful and carries a huge (10%) risk of tissue rupture. While the pain resolves after rupture of the plantar fascia, it often leads to difficult-to-manage and sometimes unsolvable foot problems, such as:
- Strain within the Longitudinal Arch
- Lateral or Dorsal Midfoot
- Exacerbation of Nerve Dysfunction
- Midfoot Stress Fracture
- Hammertoe Deformity
- Painful Walking
When the pain extends beyond 6 months without satisfactory symptom resolution, surgery is discussed. Results are excellent and more than 97% of patients report improvement.
If you have had pain for less than 6 months, nonsurgical treatment is recommended. When pain continues beyond 6 months or the pain graduates from worse in the mornings to bad both in the morning and the evening, the nerve has become involved and other options should be discussed.
For more information, read this excellent in-depth review of plantar fasciitis.