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Next Step Foot & Ankle Clinic

Using Ultrasound to Diagnose and Treat Heel Pain

"Hi, this is Dr. Silvester and I’m going to talk to you a little bit about the use of ultrasound in diagnosing heel pain and treating heel pain. I see a lot of patients who have had multiple treatments for heel pain where they haven’t been real successful. They go to their family practitioner and they’ve had an injection and it hurts a lot and those injections sometimes aren’t effective or they’re not sure if what they have is really the plantar fascia that is the problem. 
 
The use of an ultrasound, how that works in heel pain - in my mind it is the #1 most important tool in diagnosing first of all what is exactly going on with the heel, because there are two major problems with a heel that’s had pain, especially if it’s been there a long time. 
 
One is the plantar fascia ligament. You can look directly at that with an ultrasound and you can stage it immediately. You can say, “Okay, this is a moderately severe plantar fascia inflammation or degeneration,” or you can say, “This patient has no plantar fascia involvement,” and then you have to look for other origins of pain, and usually it’s a nerve. 
That’s the other major cause of heel pain is the nerve. 
 
The plantar fascia and the nerve can also act together - you can have them both. The ultrasound is an invaluable tool to help sort that out, because if you can actually look at the structure and then make a diagnosis about, “This degree of problem is the plantar fascia and this isn’t,” and then you can sort out where to address your treatments. 
 
If you’ve been to somebody about heel pain and you haven’t had an ultrasound examination, and you’re not getting anywhere - if you’re getting somewhere, great, you’re taken care of, that’s great, that’s wonderful - but if you’re not progressing the way you think you should progress, I think it might be worthwhile to get a second opinion from someone who uses an ultrasound to make the diagnosis and try to sort out what’s going on with your heel because that is a critical piece of information in being able to take your diagnosis specificity to the next level so you’re sure that what you’re doing is treating what you have. I’ve had lots of patients who have been treated for plantar fasciitis, and when I looked at their heel with an ultrasound, there’s no plantar fasciitis. They don’t have plantar fasciitis, they have nerve entrapment that’s causing their heel pain. Keep that in mind if you feel less than satisfied with the treatments that you’ve had for heel pain. Thanks for listening!"