Heel and arch pain, plantar fascia part 5. Treatment

The treatment of heel, foot, and arch pain will ultimately depend upon identifying the structures that are involved, the root causes, and the stage of the problem.

For acute situations, especially if they involve any degree of plantar ligament tearing, you will need to start with semi-rigid taping of the arch for several weeks, limiting weight bearing stress, soft standard protective insoles, botanical anti-inflammatory supplements, cold applications, and non-weight bearing active stretches. The enemy of the acute arch injury is trying to do too much to soon. Soft tissue mobilization needs to be gentle. This initial time of “rest and heal” is a good opportunity to focus on any root causes of lumbar spine, pelvic distortion, or imbalance that is causing chronic aberrant mechanical stress to the foot. Ultrasound therapy is valuable when a lot of swelling is present, especially in cases of an inflamed heel spur.

When dealing with a more chronic situation, your approach can be more aggressive: vigorous mobilization of the soft tissue scar, active weight bearing stretches, and topical or oral supplementation to improve peripheral blood flow (scar tissue lacks proper blood flow and the body cannot replace it with more supple collagen in a low oxygen situation). As with acute situations, addressing the chronic mechanical stress from the spine and pelvis is crucial to long term foot health. You need to resolve some degree of local soft tissue scarring and spinal stress to the lower extremity in order to get a good orthotics casting too. While custom orthotics are crucial in more than 50% of patients with foot pain, not all orthotics are created equal and getting the right cast at the right stage will determine if the orthotics will do the job correctly.

Foot, arch and heel pain can be a test of anyone’s patience. The range of recovery time varies between 6 weeks to 4 months. The structures involved (tendon, fascia, and ligament) have a slow turnover rate, and our feet never get a total break from the demands of daily life.