Sometimes plantar fasciitis and other causes of heel pain do not respond to standard treatments. If this is your situation, don’t worry. In the case of stubborn heel pain that just won’t go away there are a number of advanced therapies that can relieve your pain. If you are in the Seattle area you can make an appointment at the Seattle Heel Pain Center where we specialize in even the most difficult to treat heel pain. We can almost always help even if you have been to several other doctors and not found relief. If you can’t visit us, try our heel pain self treatment plan for a few weeks. If that doesn’t work look for a podiatrist in your area who specializes in heel pain.
Why does heel Pain sometimes not get better?
There can be a number of reasons that plantar fasciitis does not get better. In general, however, we can narrow these down to three primary reasons – the wrong diagnosis, the wrong treatment and the presence of a condition called plantar fasciosis.
A. The Wrong Diagnosis
Although plantar fasciitis is the most common cause of heel pain, not all heel pain is due to plantar fasciitis. So if your plantar fasciitis is not getting better one reason may be that you don’t have plantar fasciitis and treatment needs to be directed at a different condition. Other causes of heel pain include nerve entrapments,
tarsal tunnel syndrome, sciatica,
plantar fascial rupture, calcaneal stress fracture,
calcaneal apophysitis in kids,
rheumatoid arthritis and many more conditions. We can help you determine your correct diagnosis.
B. The Wrong Treatment
It’s possible you simply have not had correct treatment. There are many treatments for plantar fasciitis and other causes of heel pain and you want to make sure that your doctor is up to date on the latest research. An example of an incorrect treatment that we often see is patients who have received orthotics that were not made correctly to treat plantar fasciitis. You can
read here how orthotics for plantar fasciitis should be made. There are many other examples. We will review your entire treatment plan to ensure you receive the proper treatment.
C. Plantar Fasciosis
Sometimes chronic heel pain is due to a condition called “plantar fasciosis”. Plantar Fasciosis is a thickening or scarring of the plantar fascia that occurs due to long term inflammation of the plantar fascia. We often diagnose this problem with the use of ultrasound imaging. A normal plantar fascia is about 4mm thick where it attaches into the heel bone. If plantar fasciosis is present it may be 6mm, 7mm , or even thicker, as shown in figure
1.
Figure 1: Ultrasound of heel showing thick plantar fasica (looking at
foot upside down with toes towards the right. Solid curved white line is
the heel bone, bottom up. Plantar fascia between the + marks.)
If plantar fasciitis has been present for a long time, the fascia can be scarred and resistant to treatment. In other cases a scarring of the plantar fascia can take place.
Plantar Fasciosis Treatment
There are several treatments which are usually successful for treating plantar fasciiosis . You can use the links below to learn more about each of these treatments:
If you have chronic heel pain, contact us today for an appointment at the Seattle Heel Pain Center.
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Douglas Hale, DPM & Lawrence Huppin, DPM
Foot and Ankle Center of Washington, Seattle
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