When Physical Therapy Isn't Enough for Chronic Heel Pain

About 11% of people in the United States experience persistent heel pain. Although causes for chronic heel pain may vary, the result is the same. It’s painful to walk, run, and complete your daily chores.

Whenever possible, podiatrists recommend noninvasive lifestyle changes to help alleviate or reverse your heel pain. This may include losing weight or undergoing physical therapy (PT) to stretch and strengthen your feet and legs.

But what happens when lifestyle interventions aren’t enough to relieve your pain and PT falls short? In such cases, you may need surgical intervention, including minimally invasive surgery (MIS) when appropriate. 

Our expert podiatrists at North Park Podiatry in San Diego, California, do all they can to help you avoid surgery. However, when physical therapy and other noninvasive interventions haven’t helped, surgery may be the right choice for permanent relief.

What happens when physical therapy isn’t enough for your heel pain? The following are a few common scenarios.

Plantar fasciitis

If you’re still in pain after 6-12 months of nonsurgical interventions, our team may recommend surgery to alleviate your plantar fasciitis-related heel pain. We may choose from one of two approaches:

Gastrocnemius recession surgery

Even though you feel the pain of plantar fasciitis in your heel, an overly tight calf muscle — the gastrocnemius — may be the force behind that pain. The gastrocnemius attaches your Achilles tendon to your knee and is responsible for flexing both your ankle and your knee.

With gastrocnemius recession surgery, we lengthen this important muscle. You’re better able to flex your foot, which allows your plantar fascia to relax and relieve its pressure on your heel. You’re a good candidate for this approach if you have trouble flexing your ankle.

Plantar fascia release surgery 

If you have no trouble flexing your ankle but still have heel pain, you might benefit from plantar fascia release surgery. In this simple procedure, we partially cut the plantar fascia ligament. This loosens tension on the plantar fascia, relieving heel pain.

Persistent heel spurs

Heel spurs are bony protrusions that develop on the bottom of your heel, at the location where your plantar fascia connects to the bone. About 15% of people have bone spurs. Bone spurs develop in reaction to stress and inflammation caused by:

• Plantar fasciitis
• Other tissue damage
• Gait disorder

If you have a heel spur and undergo plantar fascia release surgery, we will remove it at that time. Heel spurs don’t usually cause pain on their own. We tend to remove heel spurs only as part of plantar fascia correction (unless they cause pain).

Achilles tendon issues 

Your Achilles tendon may just be your “Achilles heel.” This important tendon, which connects your calf muscle to your heel bone, is easy to injure. 

Through overuse or injury, your Achilles tendon may deteriorate, tear, or even rupture. Surgical repair depends on the severity and type of your injury.

We may simply remove injured tissue and stitch up the damage to your tendon. 

However, we may also need to replace the tendon with a graft from a different tendon on another part of your foot. In that case, we perform two surgeries. One removes the graft and the second replaces the damaged tendon.

Recovery means more physical therapy

Although PT alone wasn’t able to resolve your heel pain, after your surgery, it’s essential to follow through with all of your PT appointments. You may have both in-office PT sessions and be given exercises to do at home to ensure that your foot and ankle are strong and flexible.

Although surgery can completely relieve your heel pain, you must allow time for full recovery. In addition to PT, you may need to use crutches or another assistive device while your tissues heal from the trauma of surgery. 

Have PT and lifestyle adjustments not improved your heel pain? Find out how to get permanent relief by scheduling a heel pain consultation with our team by phone or by using our easy online appointment form.