Heel Pain Treatments at the Doctor's Office

There are a number of treatments which can be done by your doctor or recommended by your doctor. Some of the treatments listed below are still under investigation regarding their efficacy.

Steroid injections
Physical therapy
Custom orthotics
Hard casts
Shockwave therapy (ESWT)
Coblation therapy
Platelet rich plasma injections
Dry needling
Endoscopic plantar fascial release
Open heel surgery

Heel Pain and Plantar Fasciitis

The most common cause for heel pain is plantar fasciitis (plan –TAR   fash – ee – I – tis). This condition is classically known for causing pain in the heel at the first step in the morning. The pain can be so severe that many will limp, or grab onto a wall in order to make their way to the bathroom. After thirty minutes or so, the pain tends to work itself out.

Although this is the classic description of plantar fasciitis, it is not the only presentation of this condition. Some individuals will only experience pain in their heel when they run, walk or hike. Others will only experience pain in the arch after long periods of standing. Many people will complain only of pain in their heels at the end of a long workday. Classic descriptive terms for plantar fasciitis include stone bruise, sharp dagger, deep throbbing and dull ache. These all represent plantar fasciitis type pain. Another name for this condition is “heel spur syndrome.”  

What is plantar fasciitis?

   Plantar fasciitis is the tearing and inflammation and subsequent degeneration of the fascia, a long ligament type structure in the bottom of the foot. This is a result of small microtears in the fascia. More details on tearing of the plantar fascia. A spur can develop as a result the traction force from the fascia, but the heel spur is rarely the cause of pain. The initial phases of plantar fasciitis are inflammatory, involving pain and swelling. As the condition progresses and becomes chronic, the inflammation slowly disappears and the plantar fascia starts to deterioriate, becoming a condition called plantar fasciosis.

The plantar fascia is composed of dense, highly organized collagen fibers and is an extremely strong connective tissue band spanning the bottom of the foot. In the image to the right the plantar fascia is shown. There are three parts to the plantar fascia, the medial band, the central band and the lateral band, all seen here in the plantar fascia diagram. The plantar fascia originates on the bottom of the heel bone, called the calcaneus and extends to the toes. The fascia inserts into the base of the toes and the flexor tendons on the bottom of the foot.

In the X-rays shown here, heel spurs are seen on the bottom of the heel bones. The heel spur on the X-ray on the left is quite large, but this individual has never experienced any heel pain. The existence of a heel spur on the bottom of the foot does not necessarily mean the individual will experience heel pain. Many individuals with heel pain and plantar fasciitis, will not have a heel spur. The heel spur does not cause the heel pain.