Advanced Therapies for
Heel Pain

While most patients have their heel pain cured by standard therapies, some patients develop chronic heel pain that require advanced treatments. We use a number of advanced therapies at the Seattle Heel Pain Center.

We see a lot of different therapies advertised as “cures” for heel pain and it can get confusing trying to figure out which might be the best treatment for you. The reality is that every treatment has advantages and disadvantages. Below we will describe each therapy and link to more detailed descriptions that will give you the pros and cons of each.

Foot Orthotics for Heel Pain A number of studies support the use of foot orthotics to treat heel pain, particularly heel pain caused by plantar fasciitis These studies also show that orthotics must be prescribed in a very specific manner to be most effective for heel pain. Read here how orthotics should be made to treat heel pain.

Ultrasound Guided Injections
Steroid injections are a common and well proven treatment to rapidly reduce the pain and inflammation associated with plantar fasciitis. For more chronic cases of heel pain we often do our injections using “ultrasound guidance”. This means that we use ultrasound imaging so that we can see exactly where the injection is placed in order improve outcomes. You can read more about ultrasound guided injections here.

Using Trauma to Stimulate Healing
Long term plantar fasciitis can lead to a thickening or scarring of the plantar fascia known as plantar fasciosis. Once this occurs, standard treatments for plantar fasciitis tend not to be as effective. Newer treatments for plantar fasciosis are focused on purposely inducing trauma to the plantar fascia. This causes minor bleeding within the fascia which acts to stimulate the healing process of the tissue. Blood, oxygen and healing proteins rush to the site, causing a metabolic process that induces healing by the formation of new connective tissue. There are several therapies used to induce healing via trauma to the fascia. These include:

• Percutaneous Ultrasound Guided Approach to Plantar Fasciitis (Dry Needling)
  This is a new treatment that has shown promising results. It is a quick, minimally invasive and inexpensive option available to you in our Seattle Heel Pain Center. This technique was developed at the Department of Experimental Medicine at the University of Genoa, Italy. In a study published in 2008, researchers achieved a 95 percent success rate in completely resolving plantar fasciitis symptoms, relief that had lasted nearly a year at the time the paper was published. Detailed information on dry needling is available here.
   
• Shockwave Therapy Extracorporal shockwave therapy uses high powered shockwaves to treat heel pain like Dry Needling, It is a non-invasive, non-surgical treatment option for heel pain associated with stubborn plantar fasciitis. Shockwaves work by stimulating the healing process and promoting blood flow to the injured area. Read more here on shockwave therapy.

Radio frequency Ablation for Plantar (RFNA) Fasciitis
Radio Frequency Nerve Ablation is a minimally invasive procedure that is used to treat the pain associated with chronic heel pain and other nerve conditions. This procedure does not treat the plantar fasciitis or plantar fasciosis, but rather acts to block the nerve signal that causes the pain. Essentially, the idea is to deaden the nerve that carries the pain associated with plantar fasciitis. In RFNA the heel is numbed with a local anesthetic and then an electrode is introduced to electrically disrupt the nerve. Adjacent tissue is not damaged and the patient can walk out of the office immediately. We do not currently provide this treatment as we don’t feel there is enough evidence to support its use over other treatments. We will update this page as more information becomes available.

Platelet Rich Plasma (PRP) for Plantar Fasciitis and Achilles tendonitis PRP is a fairly new procedure where blood is drawn from the patient’s arm and then spun in a centrifuge to separate the platelets. The platelets are then injected into the damaged tissue of the plantar fascia or Achilles tendon. Although we can offer this procedure to our patients, there is very limited evidence that it is effective. Recent study demonstrated cortisone injections more effective.

The idea behind the treatment is said to be that the platelets include healing proteins that are said to stimulate the healing of damaged fascia and tendon. Currently the studies on PRP are conflicting. Some studies show quite good outcomes while others show no significant improvement. We are keeping a close watch on newer studies and will update this page when new information is available. Currently we occasionally refer to an interventional radiologist for PRP in cases of Achilles tendonitis that have not responded to other treatments.

Topaz Coblation Radiofrequency and Cryosurgery for Plantar Fasciitis These are two procedures that have been promoted over the past few years for treatment of chronic plantar fasciitis. Currently, however, there are no strong studies indicating that they are effective for the treatment of plantar fasciitis. The companies advertising these procedures state that they work like dry needling and shock wave therapy in that they act to cause trauma to the plantar fascia in order to stimulate healing. The difference is that they are considered more aggressive because they require an incision. Although our doctors have the skill to perform these procedures, our opinion is that there is not yet enough evidence that these treatments are more effective than more established treatments. Most of the studies on these techniques currently come from those with a financial incentive to promote these treatments. We will update this page as more information becomes available.

We can help you determine the best treatment for your heel pain. Contact us for an appointment at the Seattle Heel Pain Center.

1. Lemont H, Ammiratti KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. JAPMA 93(3): 234-237, 2003.
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3. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis: a prospective, randomized controlled trial. Foot & Ankle Intl 28:984-989, 2007.
4. Malay DS, Pressman MM, Assili A, Kline JT, York S, Buren B, Heyman ER, Borowsky P, Lemay C. Extracorporeal shockwave therapy versus placebo for the treatment of chronic proximal plantar fasciitis: results of a randomized, placebo-controlled, double-blinded multicenter intervention trial. JFAS 45(4): 196-210, 2006.
5. Allen BH, Fallat LM, Schwartz S. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. JFAS 46(2):75-79, 2007.
6. Takahashi N, Tasto JP, et al. Pain relief through an antinociceptive effect after radiofrequency application. Am J Sports Med 35(5):805-10, 2007.
7. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot & Ankle Intl 28:549-555, 2007.

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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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