What Is Plantar Fasciitis?

Plantar fasciitis is a foot condition in which the plantar fascia is inflamed, irritated, or injured, causing pain flares in the heels, arches, or other foot areas. The plantar fascia is a ligament made of a thick band of sensitive, web-like connective tissue that stretches across the bottom of each foot, attaching at one end to the heel bone and to the base of the toes at the other. Its primary function is to sustain impact from movement and excessive strain.

A common early sign of this condition is heel or arch pain felt with the first step of the morning. Other common experiences with plantar fasciitis pain include:

• Sharp or stabbing heel pain with first steps
• Pain after sitting or standing for long periods
• Pain that eases with movement but returns later

For a deeper dive into the exact causes and risk factors, like repetitive stress causing inflammation to the plantar fascia, read one of our dedicated plantar fasciitis posts on our blog, like this one.

 

How We Diagnose Heel Pain & Plantar Fasciitis

Plantar fasciitis is a clinical diagnosis. To confidently determine the cause of your foot pain and potentially get a plantar fasciitis diagnosis, you'll need to visit a podiatrist (like Dr. Linde here at the Foot Specialists of Birmingham). In the upcoming subsections of this content, we'll explain some of our processes in assessing heel pain and diagnosing plantar fasciitis.

What happens at your heel pain visit?

At your first visit with us to address your heel pain (and potential plantar fasciitis), we'll begin with a comprehensive overview. We'll ask you all about:

• Your symptoms and how they're affected by certain factors (e.g., things that make it worse, better, or unaffected).
• What you've already tried for relief/at-home treatment (e.g., OTC pain relief medicines or other at-home forms of basic care that make it better).
• What your typical workday is like.
• How often you exercise or play sports + the type of workouts you do or sports you're involved in.
• Your medical history (and, if it's relevant to your care, certain aspects of your close blood relatives' medical history).
• Medications you're taking.
• Any memories you have of a major moment of foot pain, like perhaps a time where you could have fallen or bumped your foot into something and brushed it off, or didn't get adequate exams/treatment.
• New or unusual life experiences that have occurred around or at the same time as the onset of your heel pain (moving, changing jobs, starting a personal fitness journey, pregnancy and childbirth, etc.).
• Anything else you think might help us understand your heel pain and find the right solution.

At that same visit, we'll also perform a physical examination. During this examination, we'll closely inspect all parts of your foot and ankle for swelling, tenderness, and alignment issues, palpate the plantar fascia, assess your range of motion and the biomechanics of your feet, calves, ankles, and toes, and evaluate gait and posture while we observe you standing and walking. If anything seems unusual or if we suspect there may be a fracture, we may call for imaging tests.

From there, we'll determine where we need to start on the treatment ladder.

Do I need X-rays or other imaging?

We are very thorough and strive to get your diagnosis right in as few visits as possible. This calculated approach also means that we avoid conducting excessive tests when we can, especially those on the more costly side (like X-rays, MRIs, and ultrasounds).

That's not to say that we won't perform imaging tests, but they're often not necessary to confirm a plantar fasciitis diagnosis or determine the source of heel pain. We'll only use imaging tests like X-rays, ultrasounds, or MRIs if your heel pain/plantar fasciitis symptoms are atypical, severe, or not improving, or to rule out other causes.

Our goal is to ensure your experience as our patient is stress-free, affordable, and productive in delivering the best treatment outcomes.

 

Our Step-by-Step Approach to Treating Heel Pain

In our approach, we don’t jump straight to surgery. Instead, we use a stepwise plan, starting with the least invasive options and progressing only if needed.

Phase 1 – Conservative Care and Load Management

The first phase of treating heel pain (plantar fasciitis induced or not) tends to involve more minimal, low-risk basic care methods and habits:

• Activity modification (not forever; just smart adjustments)
• Stretching exercise routines for plantar fascia and calves
• Supportive shoes; avoiding barefoot on hard floors
• Over-the-counter or custom orthotics, as appropriate
• Taking anti-inflammatory medications (short-term)

Many patients' heel pain improves significantly with this phase alone when it’s done consistently.

Phase 2 – Podiatrist-Guided Treatments

When conservative care isn't working or is not working enough for our patients with heel pain, we move to the next phase, which often involves prescribing slightly more rigorous treatments, and we monitor and guide them much more closely. In doing so, we design a plan around your job, sports, and how long you’ve had pain, and this treatment plan can include:

• Custom foot orthotics
• Physical therapy or a home therapy program
• Night splints, taping, or bracing
• Corticosteroid injections

Phase 3 – Advanced Options for Chronic Heel Pain

If we have administered a combination of the treatments of the last phase and you've seen little to no results, we'll offer more advanced non-surgical treatment options that we can provide here at our office, such as:

• Shockwave therapy (ESWT).
• Advanced biologic injections like PRP.
• Topaz radiofrequency microtenotomy: a minimally invasive procedure involving pricking major pain points in the heel with tiny needles that emit radiofrequency energy ("Topaz"), applying it directly to the affected plantar fascia; this procedure targets scar tissue that may disrupt the plantar fascia's healing process.

Surgery as a Last Resort

Traditional plantar fascia release surgery is rarely needed. We typically consider it only after all evidence-based conservative and minimally invasive treatments have been tried and severe pain persists.

However, if surgery is appropriate, we’ll review risks, benefits, and recovery expectations with you in detail.

 

When You Can Return to Work, Sports, and Daily Activities

With conservative care:

Many people see improvement in their heel pain after only a few weeks of conservative care, but to see a full recovery, most have to stay consistent with treatment for a couple of months. Even though that sounds like a long time, you don't necessarily have to cease all of your typical daily activities; you just need to err on the side of caution and avoid any activities that could lead to injury or excessive strain. The best way to guarantee that you're not overdoing it is to consult your podiatrist, who can provide detailed guidance.

With injections or shockwave:

With biologic injections or shock wave therapy, you only have to make some activity modifications for a short-term period. Other than that, you're usually able to keep working unless your individual treatment plan calls for more rest and less mobility than what you can accommodate while remaining functional in your role at work.

With minimally invasive procedures or surgery (if ever needed):

We’ll discuss your job and activity level in detail to create a treatment plan that suits your real-life needs. Still, after minimally invasive procedures or surgery, you have to allow yourself some recovery time, which may involve getting more rest than you're used to or making a gradual return to weight-bearing, work, or sports.

 

Why Patients in Birmingham, Hoover, and Vestavia Hills Choose Us for Heel Pain

• Heel pain expertise: Dr. Linde treats many patients with plantar fasciitis and other causes of heel pain every week, from new cases to chronic issues. You can learn more about his vast range of expertise and experience in podiatry here.
• Full spectrum of care: We don't see treatment as one-size-fits-all. From conservative plans and custom orthotics to advanced options like shockwave therapy and minimally invasive procedures, we offer a range of options for high-quality, personalized care tailored to the unique needs of each patient.
• Younger, active focus: We help runners, gym-goers, and on-the-go workers get back on their feet and return to being active.
• Convenient location: Our office is at One Independence Plaza in Birmingham, a short drive from Hoover and Vestavia Hills, with easy parking available.

 

Frequently Asked Questions About Heel Pain & Plantar Fasciitis Treatment