Is Your Plantar Fasciitis Pain Not Going Away? It's Probably Not Plantar Fasciitis

Doctors trying to get to the bottom of a person's heel pain may inadvertently cause their patients more injury if an examination doesn’t include an ultrasound, according to a new study.

It's estimated that about 10 percent of people will experience heel pain at least once in their lives. The most common cause of heel pain is plantar fasciitis, in which the ligament that connects the heel bone to the toes becomes inflamed. But other things -- like a tear in the ligament or a fatty cyst -- could be to blame, according to researcher Dr. Rock Positano, director of non-surgical foot and ankle service at the Hospital for Special Surgery in New York City.

“So many people are told that they have plantar fasciitis when they don't," Positano told The Huffington Post. "Heel pain is the great imitator, because so many things could cause it."

Positano and his fellow researchers looked back at the patient files of 143 people who came to the hospital's Joe Dimaggio Sports Foot and Ankle Center from 2006 to 2007, complaining of foot and heel pain in a total of 175 feet. The patients had all either been previously diagnosed with plantar fasciitis, or were clinically diagnosed with it after an examination at the center. Then their feet were examined with an ultrasound machine. Positano found that while the ultrasound confirmed plantar fasciitis in 73 percent of the feet, it also revealed ligament tears in 34 percent. The ultrasounds also found at least one plantar fibroma, or benign growth, in 15 percent of the feet.

The treatment for all three conditions can be very different, and in some cases even interfere with each other if a foot condition is misdiagnosed. Alternately, Positano explained, a person could have all three conditions in their foot but not know it because of the lack of an ultrasound examination.

“Sometimes I get a patient who has had heel pain for a year, and they were told to go stretch it,” said Positano. “So not only have they been treating it incorrectly, they’ve also now made it worse."

It usually takes about three to six weeks for the inflammation linked to plantar fasciitis to go down, but having a tear in the plantar fascia ligament or a growth in the foot may take anywhere from two to five months in recovery time. And stretching, which is a commonly-prescribed therapy for the treatment for plantar fasciitis, could even make the injury worse if the cause of the pain is actually a ligament tear. Ligament tears require lots of rest and sometimes even surgery, in extreme cases.

A plantar fibroma is also treated with surgery if other ways to alleviate foot pressure (such as a therapeutic insole) don’t reduce pain.

“Make sure that a diagnostic ultrasound is performed to assess what’s happening with the plantar fascia” when seeing a doctor about heel pain, advised Positano.

“Heel pain puts more stress on the other joints, like the knees, hips and back,” he concluded. “It’s not just the foot we’re talking about; were talking about everything else above it."

While plantar fibromas are generally thought to have a genetic cause, people can develop inflammation or tears in the plantar fascia ligament from wearing old shoes, shoes with no arch support, or using unsupportive shoes while exercising, Positano explained.

The study was published in the March/April edition of the Journal of the American Podiatric Medical Association.

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