What are the treatment options for left heel pain?

Treatment of Left Heel Pain

Start with conservative therapy including daily calf and plantar fascia stretching (3-5 times daily), NSAIDs, over-the-counter heel cushions and arch supports, activity modification, proper footwear, and ice massage for 10-minute periods—continuing this regimen for 6 weeks before escalating treatment. 1, 2

Initial Patient-Directed Treatment (First 6 Weeks)

The most effective first-line approach combines multiple conservative measures simultaneously:

• Stretching exercises: Regular calf-muscle and plantar fascia stretching 3-5 times daily is the cornerstone of treatment 2, 3
• NSAIDs: Oral or topical anti-inflammatory medications for pain relief and reducing inflammation 1, 2
• Cryotherapy: Ice application for 10-minute periods through a wet towel to reduce pain and swelling 1, 2
• Footwear modifications: Avoid flat shoes and barefoot walking; use shoes with proper fit, width, cushioning, and adequate arch support 1, 2
• Over-the-counter orthotics: Heel cushions and arch supports to redistribute weight and reduce pressure 1, 2
• Activity modification: Limit activities that aggravate symptoms while maintaining some mobility 2, 3
• Weight loss: If indicated, to reduce pressure on the heel 1, 2

Most patients (90%) respond to conservative treatment within 6-8 weeks 2, 3

Physician-Directed Treatment (If No Improvement After 6 Weeks)

Refer to a podiatric foot and ankle surgeon if no improvement occurs after 6 weeks of appropriate conservative treatment. 1, 2

Continue initial measures and add:

• Customized orthotic devices: More effective than over-the-counter options for persistent cases 1, 2
• Night splinting: Maintains dorsiflexion during sleep to prevent morning pain 1, 3
• Padding and strapping: Professional foot taping techniques 1, 2
• Corticosteroid injections: Use judiciously for plantar fasciitis, but never inject near the Achilles tendon due to rupture risk 1, 2, 4
• Physical therapy: Structured rehabilitation program 2, 3
• Immobilization: Cast or fixed-ankle walker-type device for severe cases 1, 2

Advanced Treatment (If No Improvement After 2-3 Months)

Continue all conservative measures and consider:

• Extracorporeal shock wave therapy: For chronic recalcitrant cases lasting 6 months or longer 1, 3, 5
• Plantar fasciotomy: Surgical option reserved for patients who fail all conservative treatments despite correction of biomechanical abnormalities 1, 3, 6
• Advanced imaging: MRI or ultrasound to confirm diagnosis and rule out other conditions (stress fracture, tumor, infection) 2, 4

Location-Specific Differential Diagnosis

The pain location guides specific treatment:

• Plantar heel pain: Most commonly plantar fasciitis—follow algorithm above 1, 2
• Posterior heel pain: Suggests Achilles tendonitis or bursitis—use open-backed shoes, heel lifts, avoid corticosteroid injections near tendon 1, 2, 4
• Lateral heel pain: Consider Haglund's deformity, lateral ligament injury, or stress fracture 2, 4
• Diffuse heel pain: Suspect stress fracture—perform calcaneal squeeze test; if positive, obtain radiographs or bone scan 4, 7
• Pain relieved barefoot but worsened by shoes: Indicates Haglund's deformity or bursitis 2, 4

Critical Pitfalls to Avoid

• Never inject corticosteroids near the Achilles tendon insertion—this significantly increases rupture risk 1, 2, 4
• Avoid complete immobilization unless absolutely necessary, as it causes muscular atrophy and deconditioning 2
• Don't delay referral beyond 6-8 weeks if conservative treatment fails—earlier specialist involvement improves outcomes 1, 2, 4
• Reexamine 3-5 days post-injury if trauma is involved, as excessive initial swelling can limit examination accuracy 4
• Consider stress fracture if patient reports increased walking activity before symptom onset, even with negative initial radiographs—technetium bone scan or MRI may be needed 4