Treatments for Heel Pain Including Shockwave Therapy

By Vincent Rogers

How is Heel Pain Treated?
Treatment for heel pain should always begin with calf stretching exercises. You should be seen by a physiotherapist who will show you precisely do calf stretching exercises properly and effectively. Simple orthotics can be beneficial. Simple heel cushions alleviate pressure from the sore part of your heel. It is advised that you try first line treatment for two to three months before seeking further treatment. For eight to nine out of ten patients with heel pain, stretching exercises and in some cases orthotics, are sufficient to ease the pain.
For those who are still in significant pain despite trying conservative treatment, it is recommended that you ask your GP to refer you to a foot and ankle specialist. They will assess you and may consider the following treatments:

• Extracorporeal shockwave therapy
• Non-steroid injections
• Surgical calf stretching

How is Heel Pain Assessed?
A consultant orthopaedic foot and ankle surgeon undertakes a full examination of your foot. You should also have an ultrasound scan. Specialist services can assess for a process known medically as neovascularity. This means that the scan shows there are too many small veins feeding the tendon, perpetuating the swelling and pain. Small nerves follow the vessels. If this is the case, injections are helpful.
About Shockwave Therapy for Heel Pain
Each session takes about 15 minutes. Patients lie on their front while the shockwave is applied with a machine which is a little like a small pneumatic press. Patients experience some discomfort during the procedure and there may be slight redness on the skin after treatment. More rarely, the heel pain becomes slightly worse after treatment before getting better. A total of three sessions are required, with intervals of no more than one to two weeks between each session.
How Does Shockwave Therapy for Heel Pain Work?
It is understood that shockwave therapy works in two ways:

• Shockwaves cause micro damage to tissue in the affected area and in so doing, stimulate healing
• The treatment has a direct effect on the nerve endings which make them less sensitive and therefore less likely to transmit pain

The benefit of shockwave therapy for heel pain is often not felt until after the third session. The treatment works well for 80 per cent of patients. The effect of the treatment is usually permanent and there is no need to return for further sessions at a later date.
NICE (National Institute for Health and Clinical Excellence) recently evaluated shockwave therapy for heel pain in August 2009. The recommendation was that the treatment is effective and should be offered, providing centres audit their results and inform patients of possible side-effects.
Surgical Calf Stretching
Known medically as Gastrocnemius Release, surgical calf stretching is an established procedure, for the treatment of heel pain. It is carried out as a day procedure and is minimally invasive, using a very small incision behind the knee. Surgical calf stretching is a way of stretching the tight calf muscle in a very controlled way and allows release of strain from the affected heel area.
Non-steroid Injections
Only non-steroid injections should be used for heel pain. This is because repeated steroid injections may lead to an increase risk of Achilles rupture.
Non-steroid injections are particularly helpful for people with neovascularity, when the Doppler scan shows there is a large number of small veins feeding a swollen tendon and perpetuating the pain. A course of three injections is normally given, with several weeks between each injection. Injections are carried out under ultrasound guidance to ensure the injection reaches the target area.

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