Heel Pain: Tendonitis and Treatment Options - Orthopedics

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Heel pain, particularly when associated with sudden onset and exacerbated by standing after prolonged sitting or upon waking, is often indicative of conditions such as Achilles tendonitis or plantar fasciitis. Given your description, it seems that the diagnosis of tendonitis aligns with your symptoms. Tendonitis refers to the inflammation of a tendon, which in your case is likely affecting the Achilles tendon, the large tendon that connects the calf muscles to the heel bone.


Understanding Tendonitis
Tendonitis can occur due to various factors, including overuse, improper footwear, or sudden increases in physical activity. In your case, the sudden onset of pain after a period of inactivity (like sitting or sleeping) suggests that the tendon may be inflamed due to repetitive strain or micro-tears that have not healed properly. The fact that you have not experienced pain in this area before could indicate that the tendon was previously healthy and that a change in activity or footwear may have precipitated the issue.


Treatment Options
1. Rest and Activity Modification: It is crucial to allow the tendon to heal. Continuing to engage in activities that exacerbate the pain can prolong recovery. You mentioned reducing your exercise; this is a positive step. Consider low-impact activities such as swimming or cycling that do not place undue stress on the heel.

2. Physical Therapy: Engaging in a structured physical therapy program can be beneficial. A physical therapist can provide targeted exercises to strengthen the muscles around the heel and improve flexibility, which can alleviate strain on the tendon.

3. Footwear: Wearing shoes with adequate support and cushioning is essential. Soft-soled shoes may not provide the necessary support for your heel. Look for shoes that offer good arch support and cushioning, or consider orthotic inserts that can help distribute pressure more evenly across your foot.

4. Ice Therapy: Applying ice to the affected area can help reduce inflammation and pain. It is recommended to ice the heel for 15-20 minutes several times a day, especially after activities that may aggravate the condition.

5. Medications: Non-steroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen can help reduce pain and inflammation. However, it is essential to use these medications as directed and consult with a healthcare provider if you have any concerns.

6. Ultrasound and Electrical Stimulation: You mentioned undergoing ultrasound and electrical therapy. These modalities can help promote healing and reduce pain, but their effectiveness can vary from person to person. If you have not seen improvement, discuss with your healthcare provider about the possibility of adjusting the treatment plan.

7. Corticosteroid Injections: In some cases, if conservative treatments fail, corticosteroid injections may be considered to reduce inflammation. However, these should be used judiciously, as repeated injections can weaken the tendon over time.

8. Surgery: This is typically a last resort and is considered only after all conservative measures have failed. Surgical options may involve removing degenerated tissue or repairing the tendon.


Follow-Up
Since you have not seen improvement after three months of treatment, it may be beneficial to follow up with your healthcare provider. They may recommend further imaging studies, such as an MRI, to assess the extent of the tendon damage or to rule out other conditions such as a partial tear or other structural issues in the foot.

In summary, heel pain due to tendonitis can be a frustrating condition, especially when initial treatments do not yield results. A comprehensive approach that includes rest, physical therapy, proper footwear, and possibly further medical intervention is essential for recovery. If symptoms persist, do not hesitate to seek further evaluation to ensure you receive the appropriate care.