Heel pain is usually plantar fasciitis; pain at the back of the heel is the Achilles tendon or its bursa; forefoot pain is often a nerve. All are visible on ultrasound and treated with a precise injection and a loading programme. Surgery is rarely needed.
The foot absorbs several times body weight with each step through the plantar fascia, the Achilles tendon and the small joints and nerves of the ankle. Tight calves, hard floors, sudden increases in activity, footwear and weight overload these structures. Diabetes reduces the foot’s ability to recover.
Examination of gait, calf tightness and tenderness; ultrasound of the plantar fascia, Achilles, bursa, ligaments and nerves; X-ray for arthritis or bony spurs.
Conditions treated
Degeneration of the plantar fascia where it attaches to the heel; sharp pain with first steps. Calf stretching, insoles and footwear first. Persistent pain: ultrasound-guided PRP into the fascia; steroid is used sparingly because of the risk of fat-pad thinning and fascia rupture. [Shockwave therapy — include if offered.]
Pain and thickening of the Achilles tendon, in the middle or at its attachment. An eccentric loading programme is the foundation; ultrasound-guided PRP for persistent cases. Steroid is not injected into this tendon.
Inflammation of the bursa between the Achilles and the heel bone; pain and swelling at the back of the heel, worse with shoes. Ultrasound-guided bursal injection, placed away from the tendon.
Most sprains heal with bracing and rehabilitation. Persistent pain or instability after three months suggests a partial ligament tear or scar; ultrasound-guided PRP with a balance programme. Referral for reconstruction when instability persists.
Wear of the ankle joint, usually years after fracture or repeated sprains. Ultrasound-guided joint injection — steroid or hyaluronic acid — and supportive footwear.
Thickening of a nerve between the toes, usually the third and fourth; burning, tingling and a feeling of a pebble under the forefoot. Wider footwear and metatarsal pads; ultrasound-guided injection around the nerve.
Compression of the tibial nerve at the inner ankle; tingling and burning in the sole. Ultrasound-guided hydrodissection and correction of foot posture; surgical release if it persists.
Ten to twenty minutes under ultrasound guidance; PRP about forty-five minutes. Walk out in your own footwear; reduce running and jumping for two weeks after a tendon or fascia injection.
The fascia tightens overnight and is stretched suddenly with the first steps. Stretching before getting out of bed helps.
Usually not. Spurs are common on X-rays of painless feet. The fascia, not the spur, is treated.
No. Steroid weakens the tendon and risks rupture. PRP and loading are used instead.
Two to six weeks after a PRP injection, built up gradually under guidance.
Yes. Foot problems are checked more carefully, healing is slower, and any skin break is treated seriously.