Heel Pain & Plantar Fasciitis
Heel pain is one of the most common foot complaints — but not all heel pain is plantar fasciitis. Accurate diagnosis is the foundation of effective treatment.
The Diagnostic Challenge of Heel Pain
The most common diagnosis for heel pain — plantar fasciitis — is frequently over-applied. While inflammation of the plantar fascia is indeed a common cause of heel pain, a significant percentage of patients labeled with plantar fasciitis actually have an entrapment of the Baxter's nerve (the first branch of the lateral plantar nerve), a condition that requires a fundamentally different treatment approach.
Dr. Bregman's expertise in peripheral nerve diagnosis allows him to identify nerve-related heel pain that is routinely missed by general practitioners and even many foot specialists. Patients who have failed multiple rounds of cortisone injections, physical therapy, and orthotics are often found to have an underlying nerve component that was never addressed.
A thorough evaluation — including clinical examination, diagnostic ultrasound, and nerve conduction studies where indicated — ensures that treatment is targeted at the actual source of pain rather than a presumed diagnosis.
Common Causes of Heel Pain
Plantar Fasciitis
Inflammation of the plantar fascia at its calcaneal insertion. Classic presentation: sharp pain with the first steps in the morning, improving with activity then worsening again.
Baxter's Nerve Entrapment
Compression of the first branch of the lateral plantar nerve. Often mimics plantar fasciitis but does not respond to standard plantar fasciitis treatment.
Heel Spur Syndrome
Calcification at the plantar fascia insertion. Note: the spur itself is rarely the pain generator — the surrounding soft tissue inflammation is.
Tarsal Tunnel Syndrome
Compression of the posterior tibial nerve at the ankle can produce heel pain, burning, and numbness along the bottom of the foot.
Stress Fracture
Calcaneal stress fractures from repetitive impact (running, military training) produce diffuse heel pain that worsens with activity.
Achilles Tendinopathy
Insertional Achilles tendinopathy causes posterior heel pain at the tendon attachment, often with a visible or palpable bony prominence (Haglund's deformity).
Treatment Approach
Conservative Measures First
Custom orthotics, stretching protocols, physical therapy, anti-inflammatory medications, and activity modification resolve the majority of plantar fasciitis cases within 6–12 months.
Regenerative Injection Therapy
Glucopuncture, platelet-rich plasma (PRP), and biological tissue allografts can accelerate healing of the plantar fascia in patients who have not responded to conventional treatment. Dr. Bregman offers these advanced regenerative options in-office.
Nerve Decompression
When Baxter's nerve entrapment or tarsal tunnel syndrome is identified as the primary pain generator, surgical decompression provides reliable and lasting relief — often in patients who have failed years of plantar fasciitis treatment.
Endoscopic Plantar Fasciotomy
For refractory plantar fasciitis that has not responded to 12+ months of conservative care, minimally invasive partial release of the plantar fascia can provide significant relief with a rapid recovery.
Stop Living with Heel Pain
An accurate diagnosis is the first step. Schedule an evaluation with Dr. Bregman today.
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