Treatment Triad for Plantar Fasciitis

Heel Pain - Getting The Proper Diagnosis

Heel pain
The first step in treating heel pain is finding out the cause of the problem.

We see many patients with heel pain in our  practice as a San Antonio podiatrist, who have had the problem for months, if not years but have never had a well defined treatment plan.
Such treatment plan starts with an accurate diagnosis.

Plantar fasciitis, inflammation of the ligament which supports that arch and originates on the heel bone is the most common cause of heel pain.   Plantar fasciitis can be caused by overuse and be transient but can often become chronic if the underlying causes are not identified and resolved. The plantar fascia is the large ligament that supports the arch and structures that support the foot.  It is strong but can be damaged over time.  The fascia has terrific tensile strength or pulling strength but is not strong when twisted. Twisting or torsional strain of the fascia occurs when overly soft shoes without support are worn or if the patient has biomechanical problems.  Overpronation, the foot rolling in too much or oversupination, the foot rolling out too much can strain the fascia causing it to become thickened and painful. The plantar fascia is not visible on x-ray so the most important first step is to obtain an ultrasound exam in the office to determine it's condition.

Treatments for chronic plantar fascia that are aimed at the cause may include use of more stable shoes (shoes with a shank), orthotics and physical therapy.  OTC orthotics or store purchase orthotics are primarily arch supports and lack the features of prescription orthotics but can be tried first.  For more information on orthotics please visit:

Occasionally, the fascia can thicken over time to where is is more difficult to treat and has been called "intractable plantar fasciitis."  The actual name for that condition is plantar fasciosis, which is a degenerative condition of the fascia.  That is readily identified by an ultrasound exam.  Plantar fasciosis includes a separate and distinct set of treatments from plantar fasciits.  Treatments for plantar fasciosis may include extracorporeal shockwave therapy (ESWT) and the Topaz Procedure:  and

Other causes may include:..

Stress fractures of the heel bone (calcaneus): 

Baxter's neuritis - a nerve entrapment of a small nerve branch beneath the heel bone:

Rrheumatologic entities such as Reiter's syndrome, rheumatoid arthritis, gout, psoriatic arthritis, irritable bowel syndrome, ankylosing spondylitis; chronic pain syndrome due to overuse of steroids (cortisone shots), plantar fascial tears, plantar fibromatosis, infections, tumors, cysts....Ed Davis, DPM, FACFAS


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