Patient Watch
OverviewPlantar FasciitisAchilles TendinopathyInsertional AchillesSlant Board

Heel Pain Education

This guide provides a comprehensive overview of common heel pain conditions and their treatments. Treatments are grouped into conventional (evidence-based clinical management) and alternative/complementary categories. Those marked with a ✅ are used by our Heel Pain Clinic.

1. Plantar Fasciitis

✅ Conventional Treatments

LEVEL 1

  • Weight loss to a healthy Body Mass Index
  • Activity modification (rest or switching to low-impact exercise)
  • Stretching exercises (plantar fascia and slant board calf stretches)
  • Footwear modifications (supportive shoes, arch support)
  • Orthotics (custom or over-the-counter insoles)
  • Night splints (to maintain a stretched position during sleep)
  • Ice massage/cryotherapy (e.g., frozen water bottle roll)
  • NSAIDs (short-term pain relief)
  • Physical therapy (manual therapy, guided rehab)
  • Taping techniques (e.g., low-dye taping)

LEVEL 2

  • Corticosteroid injections (use with caution, risk of plantar fascia rupture)
  • ✅ Shockwave therapy (ESWT)
  • Dry needling (sometimes integrated in PT)
  • Ultrasound therapy

LEVEL 3

  • Surgery (plantar fascia release – only in rare, severe, chronic cases)
  • ✅ Surgery (calf muscle release – only in chronic cases)

🌿 Alternative/Complementary Treatments

  • Massage therapy
  • Acupuncture
  • Chiropractic care (manual foot/ankle manipulation)
  • Myofascial release therapy
  • Foot reflexology
  • Supplements (e.g., turmeric, magnesium—limited evidence)
  • Essential oils (e.g., peppermint, lavender for pain relief)
  • CBD topicals (emerging anecdotal use)

2. Mid-Portion Achilles Tendinopathy

✅ Conventional Treatments

LEVEL 1

  • Weight loss to a healthy Body Mass Index
  • Stretching exercises (slant board calf stretches)
  • Eccentric heel drop exercises (Alfredson protocol)
  • Heavy slow resistance training (supervised)
  • Activity modification (reduce tendon loading)
  • Supportive footwear (cushioned soles)
  • Heel lifts (temporary use)
  • NSAIDs (may help with pain but not long-term healing)
  • Physical therapy (load progression, neuromuscular training)

LEVEL 2

  • ✅ Shockwave therapy (ESWT)
  • ✅ Prolotherapy (series of micro-injections)
  • Ultrasound or laser therapy (limited evidence)
  • Isometric loading (pain modulation)
  • Dry needling
  • High-volume saline injections – popular in some centres
  • PRP (platelet-rich plasma) injection – no/low evidence

LEVEL 3

  • Surgery (tendon clean-up. Rare, considered if >6–12 months of failed rehab)
  • ✅ Surgery (calf muscle release – only in chronic cases)

🌿 Alternative/Complementary Treatments

  • Acupuncture
  • Deep tissue massage
  • Graston/IASTM techniques (instrument-assisted soft tissue mobilization)
  • Cryotherapy
  • Topical herbal preparations
  • Supplements (collagen, vitamin C – limited evidence)

3. Insertional Achilles Tendinopathy

✅ Conventional Treatments

LEVEL 1

  • Activity modification (avoid uphill running, jumping)
  • Weight loss to a healthy Body Mass Index
  • Avoid strong calf stretches (these increase compressive load)
  • Modified loading exercises (avoid heel drops below step level)
  • Heel lifts (to reduce compressive load)
  • Footwear must not rub on heel bump (care using lifts with in-shoe elevation)
  • Physical therapy (gentle loading, gradual progression)
  • Ice/NSAIDs (for short-term pain)
  • Orthotics (to reduce mechanical stress)
  • Ultrasound therapy

LEVEL 2

  • ✅ Shockwave therapy (ESWT)
  • Injections:
    • PRP (insufficient evidence)
    • ✅ Prolotherapy
    • Corticosteroid injections – generally avoided due to rupture risk
    • ✅ Corticosteroid bursa injection – carefully with rest/boot afterwards

LEVEL 3

  • ✅ Surgery (long recovery – only if conservative treatment fails)

🌿 Alternative/Complementary Treatments

  • Acupuncture
  • Massage therapy (avoiding insertion site pressure)
  • Chiropractic/manual therapy (for adjacent joint/tissue mobilization)
  • Low-level laser therapy (LLLT – limited clinical data)
  • Supplements (collagen peptides, vitamin D, magnesium)
  • CBD topicals (emerging use, anecdotal)

✅ Treatment Summary

TreatmentPFMid-ATIns-AT
Slant Board Stretching✔️✔️✔️ (gentle)
Eccentric exercises❌✔️❌ (can aggravate)
Isometric/concentric exercises❌✔️✔️
Orthotics✔️✔️✔️
Heel lifts✔️✔️✔️
Shockwave therapy✔️✔️✔️
Hi-Volume injection❌✔️❌
Prolotherapy injection❌✔️✔️
PRP injections⚠️⚠️⚠️
Corticosteroids⚠️✔️⚠️✔️(bursa)
Surgery⚠️⚠️⚠️
Acupuncture✔️✔️✔️