There Are Many Causes of Heel Pain. Let’s Find the Right One.

Dr. Robert Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Heel pain is, without a doubt, the most common foot problem facing American adults today. Many, if not most of us, will experience it at some point in our lives. Some people have been dealing with it for months or even years, never really achieving complete relief.

But heel pain isn’t always as simple as it first seems to be. For starters, “heel pain” is not a condition or a diagnosis, but rather a symptom. And that symptom could be the product of any number of completely different, unrelated causes—or even completely separate diagnoses. Swollen tendons, stress fractures in bones, inflamed bursae, even pinched nerves are all on the table as possibilities.

And without a proper diagnosis in the first place, how are you going to get the treatment you need? Simply put, you probably won’t.

That’s why we put such a high priority on properly identifying the underlying causes of your heel pain here at Parker Foot & Ankle. We have an incredible variety of advanced and high-tech treatment options to help you get better as quickly as possible, but they aren’t going to do any good if we’re trying to treat the wrong injury!

Let’s Talk About Plantar Fasciitis for a Minute

So you may have already heard or read a lot about plantar fasciitis. This is a condition in which the plantar fascia, a band of tissue across the bottom of the foot, gets stretched or torn due to overuse. Pain tends to be located right underneath the heel, and is often worst when you first get out of bed in the morning.

Most people (including podiatrists) are told that plantar fasciitis is, by far, the most common cause of heel pain in American adults. And that’s 100% true.

But here’s what they don’t tell you:

True plantar fasciitis, in most cases, is a self-limiting condition. It is generally quite easy to treat, and in many cases if you’re responding to your pain and giving your body the rest it needs, it may even go away on its own without professional care. Not all cases are this easy, certainly. But many are.

On the other hand, most of the people who finally make an appointment with us about their heel pain are not dealing with a simple, self-limiting problem. Their pain is significant, and persistent, and has been bothering them for a long time. Simply staying off their feet doesn’t seem to be helping.

It still could be plantar fasciitis, but even if it is, it’s probably not such a simple case. And there’s a much greater chance that their problem is actually something completely different. It only seems like plantar fasciitis because that’s what we’re all trained to expect.

Unfortunately, this can even lead well-meaning, well-trained physicians to misdiagnose the initial condition—and make it that much longer and more time consuming to treat than it needs to be.

Other Heel Pain Causes

So if it’s not plantar fasciitis, what is it?

Here are a few possibilities:

  • Achilles tendinitis. The strong tendon at the back of your leg connecting your heel bone to your calf muscles may be inflamed, degenerated, or otherwise injured.
  • Bursitis. This can feel very similar to Achilles tendinitis, but is actually caused by an inflamed or ruptured bursa sac located between the Achilles tendon and the heel bone.
  • Nerve compression. Nerves in your ankle could be pinched due to general inflammation, repetitive motions, surgical mistakes, and other causes. Burning or tingling pain in the heel is a common side effect.
  • Arthritis. Joint pain could be due to wear and tear, or an autoimmune disease such as rheumatoid arthritis.
  • Stress fractures. Cracks may have developed on the surface of bones due to repetitive impacts.
  • Gout. Although the big toe is the most common target for a gout attack, heel pain is also possible.

And those are just diagnoses. There are also underlying causes to consider. For example, the following items are all fairly common contributors to heel pain:

  • Abnormal foot structures
  • Biomechanically inefficient walking gait
  • Poor quality shoes
  • Physically demanding hobbies or occupations
  • Athletic training mistakes
  • Obesity
  • Poor diet

As you can see, things can quickly get complicated!

Arriving at the Right Diagnosis

Because we understand that heel pain can be so complicated—and that the “simplest explanation” is most definitely not always right—we take a little extra time to make sure we know exactly what’s going on with your heel before prescribing a treatment.

We use the multiple etiology heel pain syndrome (MEHPS) protocol in our office to aid in diagnosis. This is an approach and questionnaire developed by Dr. Stephen Barrett, a leading heel pain expert (and friend of Dr. Parker). We also have on-site diagnostic ultrasound, which gives us a clearer picture of the soft tissues surrounding the heel than an X-ray, as well as nerve testing.

And, hey, maybe in the end the problem really is just plantar fasciitis! In fact, that would probably be the best-case scenario. But you’d be surprised at how many patients come into our office convinced that they have it … until our examination proves that their condition is totally unrelated.

Of course, once we have that diagnosis, we’ll put together a customized treatment plan that’s properly focused on the problem you actually have, and the lifestyle you want to live. It’s possible you only need very simple solutions, such as changing your training routine or picking out better pairs of shoes.

However, for those that need a little more oomph in their treatment plan, no podiatry clinic in Houston is more up to the task than we are. With laser therapy, regenerative medicine, advanced peripheral nerve surgery techniques, and other cutting-edge remedies available, we can get you back on your feet quickly and confidently.

To schedule an appointment with Dr. Parker, please give our office a call today at (281) 497-2850.

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