Heel Pain (Plantar Fasciitis) Treatments

Plantar Fasciitis is one of the most common causes of heel pain. The plantar fascia is a ligament that supports the arch of the foot. Plantar fasciitis occurs when this ligament gets over stressed, damaged and inflamed.

Cause: 

Some common causes of heel pain / plantar fasciitis include, but not limited to:

  • Weight gain
  • Excessive physical activity
  • Abnormal (gait) walking pattern
  • Improper or ill-fitting shoes
  • High impact activities (i.e. repetitive jumping, certain sports like tennis, basketball and certain exercise programs)
  • Tight calf muscles and achilles tendon

Presentation:

The heel can be painful, red, and/or swollen. The first steps out of bed or after a period of prolonged rest are very painful. Sometimes it is described as a sharp, knife-like pain in the heel with that first step in the morning. The pain improves but does not go away after those first few steps. At the end of the day, after prolonged standing or walking, the pain can get worse. This can occur in one foot or both feet.

 

Diagnosis:

  • X-Rays are taken to evaluate the heel bone for a spur and to rule out other pathology such as fractures.
  • Ultrasound can be used as needed to assess the thickness of the plantar fascia and assess for any plantar fascia tears.
  • Clinical examination will be done to assess the heel, foot, and also the achilles tendon which plays a significant role in the inflammation of the plantar fascia.
  • Gait exam to evaluate and address the underlying biomechanical problems.
 

Treatment:

  • Strapping
  • Stretching
  • Corticosteroid injection(s)
  • Regenerative Injections (ie: Amniotic and PRP)
  • Oral anti-inflammatory medication
  • Shoe gear change/modifications
  • Custom Orthotics
  • Night Splints
  • Immobilization with a cast or a walking cast boot
  • Extracorporeal Shock Wave Therapy (ESWT / EPAT)
  • Physical Therapy
   

Plantar Fasciitis can become a chronic condition if not treated. It is important to seek care when the problem first appears and to address the underlying cause rather than waiting for it to become worse.

Heel Pain in Children

As children go through “growth spurts” between the age of 11 and 14, the muscles and tendons in their legs can become tight as they try to keep up with the rapid growth in the long bones. Heel pain in children typically is the result of a tight Achilles tendon.

In children, there is a thin irregular shaped band of cartilage in the back portion of the heel bone called a growth plate (see x-ray image below). As the name implies, new bone forms within a growth plate, which is also found in other bones in the feet, legs, hands and arms.

As a child goes through a "growth spurt," the rapidly elongating leg bones stretch the Achilles tendon which in turn pulls tighter on its insertion into the heel bone. A tight tendon is usually not a problem. However, when a child is very active in sports, such as soccer, or basketball, the increased activity creates further tightening of the tendon. The result is a traction or pulling force which is absorbed into the heel bone (see illustration, below).

As cartilage is softer than bone, the growth plate frequently becomes irritated and painful as the traction force increases. This process is more commonly seen between the age of 8 and 13 years old.

On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. Other causes of heel pain include a fracture or bone tumor, so x-rays are usually performed in evaluating this condition.

Treatment includes rest, ice and anti-inflammatory medication. An arch support and heel lift are both helpful. For severe cases, a non-weight bearing splint or cast may be applied. Long term treatment usually includes use of functional foot orthotics. The problem is self-limiting and goes away after the growth plate closes, around the age of 13 to 14 years old.

FASMA Doctors Performing This Specialty / Service

Dr. Ian Beiser

Washington, DC (19th Street)
Dr. Jason Birkel

Hampton, VA Newport News, VA
Dr. Man Cho

Reston, VA
Dr. Louis DeFazio

Clarksville, MD
Dr. Reema Dua

Rockville, MD (North Bethesda)
Podiatrist Dr. Mo Esmaili DPM Dr. Mohammad Esmaili

Kensington, MD
Dr. Casey Friske

Clarksville, MD
Podiatrist Dr. Ira Gottlieb DPM Dr. Ira J. Gottlieb

Pasadena, MD
Dr. Adam Grahn

Greencastle, PA Hagerstown, MD
Dr. Brandy Grahn

Gettysburg, PA Hagerstown, MD
Dr. Michelle Le

Rockville, MD (North Bethesda)
Dr. Enzo J. Leone

Pasadena, MD
Dr. Andrew Liss

Columbia, MD Kensington, MD
Podiatrist Dr. Eric Masternick DPM Dr. Eric Masternick

Reston, VA
Dr. Alexander Mount

Richmond, VA
Dr. Jenny Nguyen

Pasadena, MD
Dr. Alex Olivera

Columbia, MD Kensington, MD
Dr. Robert Pica

Richmond, VA
Dr. Mark Roemer

Hagerstown, MD
Dr. Betsy F. Rosenthal

Hagerstown, MD
Dr. Seth Rubenstein

Reston, VA
Podiatrist Dr. Gina M. Saffo DPM Dr. Gina M. Saffo

Annapolis, MD Greenbelt, MD
Dr. Sagar Shah

Colonial Heights, VA Richmond, VA
Dr. Gregory Smith

Gettysburg, PA Hagerstown, MD
Dr. Mitchell Waskin

Richmond, VA

Locations

  1. Silver Spring, MD (Fenton)
    8630 Fenton Street Suite 1
    Silver Spring, MD 20910
    Phone: (301) 587-5666
    Fax: (301) 589-4479

  2. Washington, DC (1775 K Street)
    1775 K Street NW Suite 580
    Washington, DC 20006
    Phone: (202) 331-9727
    Fax: (202) 887-0741

  3. Charlottesville, VA (Abbey Road)
    2050 Abbey Road Suite C
    Charlottesville, VA 22911
    Phone: 434-295-4443
    Fax: 434-295-8598

  4. Culpeper, VA
    530 Sunset Lane Suite A
    Culpeper, VA 22701
    Phone: 540-825-6113
    Fax: 540-825-4937

  5. Washington, DC (19th Street)
    1145 19th Street NW Suite 605
    Washington, DC 20036
    Phone: (202) 833-9109
    Fax: (202) 833-5762

  6. Clarksville, MD
    6100 Day Long Lane Suite 208
    Clarksville, MD 21029
    Phone: (443) 535-8770
    Fax: (443) 535-8775

  7. Mt Airy, MD (South)
    1502 S. Main Street Suite 307
    Mt Airy, MD 21771
    Phone: 301-829-2244
    Fax: 301-696-8872

  8. Frederick, MD (Thomas Johnson Drive)
    63 Thomas Johnson Dr Suite C
    Frederick, MD 21702
    Phone: (301) 696-0818
    Fax: (301) 696-8872

  9. Hampton, VA
    2210 Executive Drive Suite E
    Hampton, VA 23666
    Phone: (757)-896-8800
    Fax: (757)-896-8832

  10. Newport News, VA
    754 McGuire Place
    Newport News, VA 23601
    Phone: (757) 599-5710
    Fax: (757) 591-0522

  11. Holly Springs, NC
    1004 Werrington Drive, Ste. 300
    Holly Springs, NC 27540
    Phone: 919-850-9111
    Fax: 919-850-2499

  12. Raleigh, NC (Millbrook)
    1418 E. Millbrook Road
    Raleigh, NC 27609
    Phone: 919-850-9111
    Fax: 919-850-2499

  13. Rockville, MD (Shady Grove Rd)
    15215 Shady Grove Rd Suite 307
    Rockville, MD 20850
    Phone: (240) 268-7450
    Fax: (301) 949-8833

  14. Wheaton, MD
    2730 University Blvd. W. Suite 1000
    Wheaton, MD 20902
    Phone: (301) 949-3668
    Fax: (301) 949-8833

  15. Charlottesville, VA (Rio East Ct)
    887 Rio East Ct. Suite A
    Charlottesville, VA 22901
    Phone: 434-979-8116
    Fax: 434-979-8880

  16. Fishersville, VA
    66 Parkway Lane Suite 102
    Fishersville, VA 22939
    Phone: 540-949-5150
    Fax: 540-932-8535

  17. Reston, VA
    1860 Town Center Drive Suite 220
    Reston, VA 20190
    Phone: (703) 391-0211
    Fax: (703) 880-1192

  18. Rockville, MD (North Bethesda)
    11801 Rockville Pike Suite 105
    Rockville, MD 20852
    Phone: (301) 881-6222
    Fax: (301) 881-1639

  19. Kensington, MD
    10901 Connecticut Avenue Suite 200
    Kensington, MD 20895
    Phone: (301) 949-2000
    Fax: (301) 949-2002

  20. Chevy Chase, MD
    5530 Wisconsin Avenue Suite 945
    Chevy Chase, MD 20815
    Phone: (301) 913-5225
    Fax: (301) 913-9145

  21. Washington, DC (2021 K Street)
    2021 K Street NW Suite 520
    Washington, DC 20006
    Phone: (202) 223-4616
    Fax: (202) 223-0740

  22. Silver Spring, MD (International Drive)
    3801 International Drive Suite 204
    Silver Spring, MD 20906
    Phone: (301) 598-0130
    Fax: (301) 598-5091

  23. Pasadena, MD
    8028 Governor Ritchie Hwy Suite 100
    Pasadena, MD 21122
    Phone: (410) 768-5800
    Fax: (410) 768-5806

  24. Frederick, MD (Solarex Ct)
    604 Solarex Court Suite 103
    Frederick, MD 21703
    Phone: (301) 698-9260
    Fax: (301) 698-8962

  25. Greencastle, PA
    50 Eastern Ave Suite 122
    Greencastle, PA 17225
    Phone: 717-643-0795
    Fax: 717-643-0833

  26. Hagerstown, MD
    11110 Medical Campus Road Suite 100
    Hagerstown, MD 21742
    Phone: (301) 739-1575
    Fax: (301) 739-1578

  27. Gettysburg, PA
    506 W. Middle Street
    Gettysburg, PA 17325
    Phone: 717-778-3338
    Fax: 717-778-3340

  28. Silver Spring, MD (MedStar-Leisure World)
    3305 N Leisure World Blvd.
    Silver Spring, MD 20906
    Phone: 301-598-0130
    Fax: 301-598-5091

  29. Columbia, MD
    11055 Little Patuxent Pkwy Suite 204
    Columbia, MD 21044
    Phone: (410) 730-2623
    Fax: (410) 992-4779

  30. Annapolis, MD
    129 Lubrano Drive Suite 303
    Annapolis, MD 21401
    Phone: (410) 266-7575
    Fax: (410) 266-7366

  31. Silver Spring, MD (White Oak)
    2415 Musgrove Road Suite 103
    Silver Spring, MD 20904
    Phone: (301) 384-6500
    Fax: (301) 384-6670

  32. Richmond, VA
    1465 Johnston Willis Drive
    Richmond, VA 23235
    Phone: 804-320-3668
    Fax: 804-320-2600

  33. Carrollton, VA
    13609 Carrollton Boulevard Suite 11
    Carrollton, VA 23314
    Phone: (757)-238-9600
    Fax: (757)-238-8750

  34. Greenbelt, MD
    7501 Greenway Center Dr Suite 810
    Greenbelt, MD 20770
    Phone: (301) 577-4464
    Fax: (301) 577-4702

  35. Orange, VA
    175-C Spicers Mill Road
    Orange, VA 22960
    Phone: 540-672-1402
    Fax: 540-825-4937

  36. Colonial Heights, VA
    4730 Puddledock Rd.
    Prince George, VA 23875
    Phone: 804-320-3668

  37. Urbana, MD
    3430 Worthington Blvd Suite 101
    Urbana, MD 21704
    Phone: 301-696-0818

  38. McConnellsburg, PA
    214 Peach Orchard Road
    McConnellsburg, PA 17233
    Phone: (301) 739-1575
    Fax: (301) 739-1578