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Q. Please advise the best treatment for heel pain.

Answered by
Dr. Akshay Kumar Saxena
and medically reviewed by iCliniq medical review team.
This is a premium question & answer published on Dec 09, 2017 and last reviewed on: Oct 13, 2022

Hi doctor,

I have started getting heel pain after exerting in tennis. Please see the photo of the pain area marked in red. Initially, I had continuous pain while walking. It is slightly more on the first few steps after rest or sleep. My physiotherapist suggested it could be a plantar fasciitis and I am undergoing physiotherapy sessions. Had ultrasound and TENS, four sessions. Apart from that I am doing stretching exercise and ice pack at home. Hot water on foot did not help much. The pain is ongoing for 15 days and does not seem to be improving much. Please advise the best treatment options. Also, do you observe any calcification in the x-ray? I have attached my x-ray for your reference. How long will it take to heal?

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#

Hello,

Welcome to icliniq.com.

  • You have mentioned pain in the area of heel region, which has been marked by you and it looks like plantar fasciitis, which has already been mentioned to you.
  • Just let me know whether there are any other signs and symptoms of inflammation like skin redness, local warmth, any swelling or any other symptoms like fever, etc.
  • If there is none, then just let me know your uric acid levels if you have recently got them done.
  • In any case pain in the heel region if there are no other significant history of injury or any other symptoms is suggestive of plantar fasciitis for which the treatment is explained below. Consult your specialist doctor, discuss with him or her and take the treatment with consent.
  • The treatment is aimed at offloading the inflamed fascia, which is usually done by a proper footwear modification. Use silicon insoles and air heel, which is meant for plantar fascitis only.
  • Use of ice packs intensively for three to four times in a day for 10 to 15 minutes every time also helps in relieving inflammation.
  • You can also use an analgesic spray like Dynapar QPS spray (Diclofenac) for local application after fomentation.
  • Also, I suggest a gentle anti-inflammatory medication like tablet Durapain (combination of Diclofenac and Tramadol) one tablet twice a day or tablet Hifenac P (combination of Aceclofenac and Paracetamol) one tablet twice a day after meals for five to seven days.
  • As you have mentioned continue with your physical therapy modalities and add laser therapy if it is available.
  • Also, there is no significant calcification for you to worry in the x-rays as I have gone through your films (attachment removed to protect patient identity).
  • Please let me know after two to three weeks how you are feeling. If the pain does not decrease, then injections might have to be given to relieve inflammation.

The Probable causes:

Heel fascia Inflammation.

Regarding follow up:

Revert back after two to three weeks to an orthopaedician and traumatologist online.---> https://www.icliniq.com/ask-a-doctor-online/orthopaedician-and-traumatologist

My uric acid level is given below. This was done in Jan 2016
URIC ACID PHOTOMETRY 4.65 mg/dl
There is no redness and warmth. Only symptom is heel pain while walking.
Will the kinesio tape help for Plantar Fascitis?

(JFYI: For my back you had suggested a cortisone injection and after injection my back is better. The initial symptom of pain when walking on a hard surface is not there. Focusing on weight loss and exercises)
# Hello ,

Thanks for contacting with me again on Icliniq.

I think you have some dull pain on the back side of your heel and as per you there are no s/s of inflammation there.
So we can attribute that pain to a local cause only.

If physio with footwear modification is not helping you, then a local steroid injection can be given at the most tender point as it can relieve you of inflammation. But if you want you can continue with sports shoes/air heel which was described by me earlier and this pain may subsequently subside.
We have to make sure that there should not be persistent pressure on that inflamed area.

Secondly physical therapy needs to continue not only for your Heel pain but also for back pain which means regular exercises, posture counseling, general conditioning and Abdominal strengthening exercises.

Lastly adequate Calcium and Vitamin D Intake will keep your bone metabolism healthy.
Also Ice packs are indicated for any pain that is of acute onset or if there has been a recurrence of a chronic symptom, otherwise you can do Hot packs for chronic inflammatory pain.

Also if Diclofenac is causing a lot of acidity, then you can try Etoricoxib 60 mg twice a day which comes by name of Etoshine but combine an antacid along with it, or otherwise you can take Tab Ultracet twice a day for 3-5 days which will not cause any acidity but can induce a bit of Nausea or vertigo etc.

Do not hesitate to get back to me should you need any further information / SOS

Thanks & Regards
The Probable causes:

Heel Fascia Inflammation
? Degenerative Disc Lower Back region

Treatment plan:

As advised

Regarding follow up:

Follow up after 3 weeks / SOS


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