What is the treatment for right heel pain that worsens after rest and with jumping?

Treatment for Right Heel Pain Worsening After Rest and with Jumping

The most effective initial treatment for right heel pain that worsens after rest and with jumping is a combination of rest, activity modification, NSAIDs, stretching exercises for the plantar fascia and Achilles tendon, and appropriate footwear or orthotic devices. 1, 2

Diagnosis

Based on the symptoms described, this presentation is most consistent with plantar fasciitis:

• Pain worsening after rest (particularly first steps in the morning) is a classic sign of plantar fasciitis 1, 3
• Pain exacerbated by jumping activities suggests stress on the plantar fascia 1, 3
• Location in the heel is typical of plantar fasciitis 3

Treatment Algorithm

First-Line Treatment (0-6 weeks)

• Rest and activity modification to prevent ongoing damage and reduce pain 1, 2

  • Reduce high-impact activities like jumping
  • Modify exercise routine to include low-impact activities

• NSAIDs for pain relief and inflammation reduction 1, 2, 4

  • Options include naproxen or ibuprofen
  • Naproxen has been shown to effectively control pain in tendonitis and bursitis with fewer gastrointestinal side effects than some alternatives 4
  • Use with caution in patients with gastrointestinal, cardiovascular, or renal risk factors 4, 5

• Stretching exercises for the plantar fascia and Achilles tendon 1, 2

  • Perform several times daily, especially before first steps in the morning
  • Include eccentric exercises which have proven beneficial for tendinopathies 2

• Footwear modifications and orthotic devices 1, 2

  • Proper shoes with adequate cushioning and arch support
  • Heel cushions, arch supports, or over-the-counter orthotics
  • Custom orthotics may be considered if over-the-counter options fail

• Ice application (cryotherapy) for 10-minute periods through a wet towel to reduce pain and swelling 2

• Weight loss if the patient is overweight, to reduce pressure on the heel 1, 2

Second-Line Treatment (if no improvement after 6-8 weeks)

• Night splints to maintain dorsiflexion during sleep (particularly effective for chronic pain lasting more than 6 months) 1, 6

• Physical therapy for more structured exercise program and modalities 1, 2

• Consider corticosteroid injections for short-term pain relief 1, 2, 6

  • Use judiciously due to potential complications
  • Avoid injections near the Achilles tendon due to risk of tendon rupture 1, 2

Third-Line Treatment (for recalcitrant cases)

• Referral to specialist (podiatrist or orthopedic surgeon) if no improvement after 6-8 weeks of appropriate conservative treatment 1, 2

• Advanced imaging (MRI, ultrasound) to confirm diagnosis and rule out other conditions 2

• Consider extracorporeal shock wave therapy for chronic cases (>6 months) 3, 6, 7

Common Pitfalls and Caveats

• Corticosteroid injections should be used judiciously and are contraindicated near the Achilles tendon due to risk of tendon rupture 1, 2

• Complete immobilization should be avoided to prevent muscular atrophy and deconditioning 2

• Failure to address biomechanical factors (such as excessive foot pronation) may lead to treatment failure 3

• Overlooking other causes of heel pain such as stress fracture, Achilles tendonitis, or neurologic causes that may require different treatment approaches 1, 8

• Expecting immediate results - conservative treatment typically requires 6-12 weeks for significant improvement, with 90% of patients improving with conservative techniques 3