Heel pain is one of the most common, but painful conditions suffered in the foot and ankle. Pain is usually present under or behind the heel with emphasis seen during the first steps in the morning. There are two different conditions that tend to go hand in hand (or in our case, foot in foot) with each other.

The most common cause of heel pain is plantar fasciitis: inflammation to the tissue band under the foot that connects your heel to your toes. The symptoms are mild and achy at first, but worsens and can linger throughout the day if untreated. .

When plantar fasciitis continues for an extended period of time, a calcium deposit can form at the connection of the fascia tissue band to the heel bone. This is called a heel spur and is often a result of plantar fasciitis, not a cause. X-rays would be taken to assess the formation of a heel spur and treatment planning.



Plantar fasciitis is typically an overuse injury localized to the bottom of the heel. Other factors known to cause the condition include trauma, increase of activity, increase of weight gain, new shoes or inserts. Patients are more inclined to get the condition if they consistently wear unsupportive shoes or , predominantly stand & walk on hard surfaces.

Biomechanics explains the way you walk which becomes an important contributing factor on how plantar fasciitis progresses. Individuals with tight calf muscles tend to have a limitation on the amount the ankle flexes. This results in your heels to adjust by “rolling inwards” or pronating directly to the plantar fascia, irritating to the tissue band.

The condition starts gradually as mild pain to the heel bone, but can progress with each day left untreated. As the fascia is irritated at the heel bone, a bone spur can form. Often, the spur can impinge on a local nerve, causing a burning sensation to the area.

When plantar fasciitis is left untreated, a chronic condition can occur with possible scar tissue formation. Chronic conditions tend to change the way people walk, resulting in compensation and pain in their knees, hips and lower back.


  • Pain to heel with first steps in the morning or after periods of rest
  • Pain initially relieved or improved after continuation of walking
  • Throbbing or sharp pain directly to inner heel after long day of standing or walking
  • Swelling and tenderness to inner heel
  • Burning and tingling sensation to bottom or back of heel


Approximately 90% of patients with plantar fasciitis significantly improve with conservative options. Conservative options include that treating the pain while also controlling the mechanics of the foot for prevention. These can include or be a combination of:

  • Prescription anti-inflammatories
  • Steroid injections
  • Shoe inserts
  • Custom orthotics
  • Braces or splints
  • Stretches or physical therapy
  • Proper shoe gear

At Premier Foot & Ankle, we’re proud to offer an advanced and new conservative option called EPAT or Shockwave therapy. The treatment involves shockwaves sent to the inflamed area, resulting in a breakdown of scar tissue and inflammation, allowing for growth of healthy, stronger tissue. The treatment has shown to have a very high success rate to our patients and is a great alternative to surgery!

On the rare instance that conservative options fail, surgery would be indicated. The severity of the condition often dictates what procedures are used.

A common procedure involves lengthening the plantar fascia through a small incision, allowing the tissue to stretch and offload the tightness formed by inflammation.

Other options include minimally invasive techniques to reduce inflamed and scarred tissue. This type of procedure has a quick recovery period and you are often back on your feet in days!

If you are exhibiting early indication of pain or discomfort, visit your podiatrist at Premier Foot & Ankle for care!


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