How To Wash Away Heel Pain With Water

San Antonio Podiatrist Washes Away Tough Cases of Heel Pain With Water











Stress Fractures of the Calcaneus (Heel Bone)

















Calcaneal stress fracture1


For more information visit:  Podiatrist San Antonio

MEHPS or Multiple Etiology Heel Pain Syndrome



Dr. Barrett discussed the concept of the multifactorial causes of heel pain in 2006 in this article:     Importantly, he advised practitioners, in the article, to broaden their approach to the diagnosis and treatment of heel pain.  Old paradigms take time to change but hopefully his Heel Pain Boot Camps will accelerate the understanding and application of these concepts.

We are taught, in our training, the motto:  "If you hear hoofbeats, don't think of zebras."  That advice means that if a patient has a symptom, always start with the most common cause, not the more "obscure" or exotic causes.  It is true that plantar fasciitis represents about 93% of heel pain.  Nevertheless, true plantar fasciitis, which is an inflammation of the plantar fascia is often self limiting and relatively easy to treat.  It is for that reason, that podiatrists may not see that much plantar fasciitis....we see patients with heel pain that has persisted and is not self limited.  In other words, the patients we see with heel pain probably represent a population whose heel pain causes go beyond simple plantar fasciitis.

Traditionally, patients who present with heel pain may have an x-ray performed.  What does an x-ray show?  Bone and joint but not ligaments, tendons and nerves.  The plantar fascia is a ligament.  A ligament can be seen via diagnostic ultrasound or MRI.  MRI may be needed under some circumstances but not used routinely.  Office based diagnostic ultrasound (sonography) is thus the gold standard in the diagnosis of heel pain and should be the first test performed as opposed to x-ray.

High resolution ultrasound can also allow visualization of nerves with attention to the type of nerve problems that can cause heel pain such as tarsal tunnel syndrome, medial calcaneal neuritis and Baxter's neuritis.

It is not uncommon for us to encounter patients in our offices who have had heel pain for many months or even years and are convinced that they have the toughest cases of plantar fasciitis only to discover, upon sonographic exam, that their heel pain is not caused by plantar fasciitis.

Dr. Ed Davis, Podiatrist San Antonio, 210-490-3668


Achilles heel iStock_000047636266_Large (2)



What causes functional equinus?










Treatment of functional equinus.





Dr. Ed Davis  Podiatrist San Antonio  210-490-3668







Orthotics and Heel Pain


The plantar fascia is very strong in terms of tensile strength (pulling strength) but is prone to damage when twisted either excessively or repetitively, AKA torsional strain. Too much pronation (inward rolling) of the foot or too much supination (outward rolling) is what can cause such twisting of the fascia. That is a bit of an oversimplification because when the back of the foot rolls in, the front of the foot rolls out in response.

Orthotics are devices which change the mechanics or function of the foot. There is not a rule or strict definition of an orthotic so vendors can apply the label “orthotic” to almost anything one can place in a shoe, from insoles to arch supports.

There are three broad categories of foot orthotics, prefabricated or OTC orthotics, customized orthotics and custom orthotics.

1) Prefabricated or OTC orthotics: Inserts that are mass produced and sold by shoe size. They primarily act as arch supports and can be helpful in reducing overpronation. Some of our favorite brands are Powerstep, Superfeet, Sole and Redithotics. The cost of prefabricated orthotics ranges from about $15 to $50 and can be found at retail outlets and occasionally at medical provider's offices. There are some types of prefabricated orthotics being marketed as “custom” at retail outlets for substantially higher prices so “buyer beware.”

2) Customized orthotics: These are prefabricated orthotics that have been molded, modified or changed by a healthcare professional to make them work better. 

3) Custom orthotics: This refers to orthotics that are provided by a healthcare professional, often a podiatrist. The podiatrist first performs a biomechanical exam of the feet and legs to determine the optimal prescription, then, takes a mold of the foot while holding it in a semi-corrected position. Keep in mind that such a mold cannot be made by having the patient standing because the foot will tend to go to the position that is causing problems.

For a more detailed explanation of foot orthotics visit our website:


Podiatrist San Antonio discusses alternate causes of heel pain


Here is a partial list of heel pain causes:

1) Gout       Gout is a metabolic disease in which the body collects too much of a waste product, uric acid.  Uric acid levels can be raised because the body makes too much uric acid or because it has difficulty excreting it.

2) Rheumatoid arthritis    Rheumatoid arthritis is a form of arthritis due to antibodies formed to the bodies own tissues, most commonly tissues in joints.  It is a fairly common cause of heel pain.

3) Reiter's syndrome, ankylosing spondylitits and psoriatic arthritis   This group of arthritic conditions are known as HLA-B27  arthritides due to the gene involved and can cause heel pain.

4) Osteoid osteoma  This is a benign tumor of the heel bone that often causes heel pain at night.

5) Stress fracture   A stress fracture is a fracture, often a hairline fracture, that is caused by overuse.  The best way to visualize a stress fracture is to take a paper clip and bend it several times. It may break in two by the fourth bend but consider if that paper clip is normal after it has been bent 3 times.  A magnifying glass or microscope would show tiny fractures in the paperclip at that point.  Unlike the paper clip, our bodies are building up tissue and breaking them down.  If the breakdown process exceeds the repair then stress fractures can occur.  Stress fractures are more likely to occur when bone is weakened as in osteoporosis or osteopenia.

6)  Infections   Infections of the heel bone can occur due to direct trauma such as puncture wounds or spread from nearby wounds.   Infections in other parts of the body such as dental infections can spread by the blood to the heel.

Heel pain in youth - calcaneal apophysitis or Sever's disease




















ESWT or extracorporeal shockwave therapy for the treatment of heel pain






ESWT is a treatment for plantar fasciosis, not plantar fasciitis.

ESWT is a treatment for Achilles tendinosis., not tendinitis.





IStock_000040512110_Large (1)

Baxter's neuritis, a common cause of heel pain

NerveiStock_000070318367_Large (2)
Baxter's nerve








