What to do when heel pain isn’t going away?
If you are suffering from heel pain, you wouldn’t need me to tell you that it can be stubborn and frustrating at times!
For many patients, the traditional approach is ineffective at this time, alternative treatments can be useful to help those patients overcome heel pain.
Chronic pain under the bottom of your heel is often as a result of collagen degeneration at the insertion of a significant foot ligament called the plantar fascia often referred to as “plantar fasciitis”. The plantar fascia is responsible for transferring force from your heel to forefoot during normal walking. Chronic repetitive stress where the ligament inserts into the base of the heel bone results in degeneration and scar tissue developing.
Plantar fasciitis often causes heel pain first thing in the morning and after rest. More advanced cases, the chronic degeneration leads to small tears developing with coincides with an increase in pain and difficulty achieving relief with the conventional treatment.
Traditional treatments of plantar fasciitis focus on relieving the mechanical load on the attachment of the plantar fascia to the heel bone. This can include the use of orthotics or shoe inserts, rest, changing footwear, heel lifts, strapping and night splints. Sometimes when these treatments are ineffective, a corticosteroid injection or anti-inflammatories are used to help manage pain.
These treatments can work to varying, however in some cases the traditional approach doesn’t cut it. It is often at this stage, my clients become frustrated with the impact that heel pain is having on their lifestyle and require additional treatment.
When the tradition doesn’t approach work, what are the options?
- Swiss DolorClast® (Shockwave Therapy)
- Tissue Regenerative injection ( Prolotherapy or PRP)
- Cortisone injection
What is Swiss DolorClast®, What does the science say?
Swiss DolorClast® is a form of Shockwave therapy, soundwaves create high-energy vibrations within the tissue. These unique acoustic pressure waves produced outside the body are helpful to heal chronic musculoskeletal conditions. Shockwaves enhance healing due to the increased production of growth factors.
How does shockwave compare to cortisone injections?
There are currently four scientific studies that compared head-to-head shockwave therapy versus cortisone injection for patients suffering from plantar fasciitis. The consensus from these studies is that shockwave provided better long term improvement compared to a cortisone injection. These studies showed superior improvement in the shockwave group compared to the cortisone group at both the 3 months on six-month follow-ups.
Cortisone is a potent anti-inflammatory, this often results in early pain relief; however, as the medication wears off (usually after 4-6 weeks) the pain relief can be short-lived.
A side effect of cortisone is that it can weaken the tendon or ligament that it is injected into and cause damage to the surrounding soft tissue is known as atrophy, these complications are more common with repeated injections of cortisone.
How to shockwave compared to platelet-rich plasma (PRP) injections?
Platelet-rich plasma is a form of injection therapy. It involves taking some of you blood just like a standard blood test, your blood is then placed into a centrifuge to separate it into the main components.
It is well known the platelets contain high concentrations of growth factors which can be necessary for healing. By injecting your own platelets back into the injured area, you can provide boosting growth factors and help stimulate healing. Shockwave also causes increasing growth factors; however, it does so by stimulating the local cells to produce growth factors in response to the pressure waves.
Two studies have compared the PRP injection to shockwave therapy. The randomised study, Chew and coworkers studied 54 patient’s with chronic heel pain (6 months or greater), they found significant improvement in both groups.
It is necessary to address the underlying factors that are contributing to your heel pain, and it is also essential to assess the biomechanics and implement interventions to address them if they are a contributing factor.
Swiss DolorClast® Shockwave is a very safe non-invasive treatment that has shown consistently in medical research to be more effective than cortisone injection and as effective at PRP injections.
My Sports Podiatrist Founder, James Ferrie is a Swiss DolorClast® Master Class trainer, having used the techniology to help thasounds of people sufferring with heel pain.
Yucel I, Ozturan KE, Demiraran Y, Degirmenci E, Kaynak G. Comparison of high-dose extracorporeal shockwave therapy and intralesional corticosteroid injection in the treatment of plantar fasciitis. J Am Podiatr Med Assoc. 2010;100(2):105-110.
Xu D, Jiang W, Huang D, et al. Comparison between extracorporeal shock wave therapy and local corticosteroid injection for plantar heel pain. Foot Ankle Int. 2020;41(2):200–205.
Lai TW, Ma HL, Lee MS, Chen PM, Ku MC. Ultrasonography and clinical outcome comparison of extracorporeal shock wave therapy and corticosteroid injections for chronic plantar fasciitis: a randomised controlled trial. J Musculoskel Neuronal Interact. 2018;18(1):47-54.
Hocaoglu S, Vurdem UE, Cebicci MA, Sutbeyaz ST, Guldeste Z, Yunsuroglu SG. Comparative effectiveness of radial extracorporeal shockwave therapy and ultrasound-guided local corticosteroid injection treatment for plantar fasciitis. J Am Podiatr Med Assoc. 2017;107(3):192-199.
Chew KTL, Leong D, Lin CY, Lim KK, Tan B. Comparison of autologous conditioned plasma injection, extracorporeal shockwave therapy, and conventional treatment for plantar fasciitis: a randomised trial. Phys Med Rehab. 2013;5(12):1035-1043.
Mr James Ferrie
B. Pod. (La Trobe); Mem. A. Pod. A
Principal Practitioner / Founder of My Sports Podiatrist