When Your Foot Pain is not Plantar Fasciitis

When Your Foot Pain

When you seek treatment for heel pain, chances are high that you will be diagnosed with plantar fasciitis, which is responsible for roughly 70 percent of all reported cases of foot pain. Yet that leaves 30 percent of cases where heel pain generates from another source. Because plantar fasciitis is so common, other sources of heel pain are often overlooked, meaning that treatment may sometimes be misdirected.

Other Sources of Heel Pain

The plantar fascia is a long fibrous ligament that spans the bottom of your foot, connecting your heel bone to your toes. The PF supports your foot arch and provides shock absorption. It also serves as a sort of spring, to help propel you as you walk, run and jump. The plantar fascia can become irritated and inflamed, causing heel and foot pain that make walking, running and standing uncomfortable.

However, there are a number of other sources of foot and heel pain, and they should be considered during diagnosis to ensure treatment targets the actual cause of pain.

Common causes of foot and heel pain other than plantar fasciitis include:

  • A tear in the plantar fascia that may co-exist with plantar fasciitis
  • Tarsal tunnel syndrome
  • Baxterтs nerve entrapment
  • Stress fracture of the heel bone
  • Cysts on the heel bone
  • A tear in the short flexor tendon
  • Gout
  • Arthritis

Because there are so many possible causes of heel pain, accurate diagnosis is essential to developing the best treatment plan.

Diagnosis of Foot and Heel Pain

Diagnostic ultrasound can accurately visualize the structures in the foot and heel in real time, including bones, muscles, tendons, ligaments and nerves, to help pinpoint the exact cause of heel pain. Because ultrasound provides immediate results, treatment can begin right away, helping speed up the healing process.

Seeking Treatment

When seeking treatment for heel pain, look for a rehab clinic that offers individualized therapy based on sound diagnosis. Treatment for plantar fasciitis will differ from treatment for other heel pain issues. An important part of healing is correcting the source of heel pain.

Once pain and inflammation have abated and healing is well underway, your therapist may prescribe a number of solutions, including:

  • Gait analysis and retraining
  • Stretching exercises
  • Strengthening exercises
  • Athletic taping
  • Postural correction
  • Shoe orthotics

Note that eliminating pain symptoms does not necessarily mean you have eliminated the source of pain. Look for a foot pain specialist who goes beyond pain treatment to identifying and treating the root cause of your symptoms.

Foot Pain Specialists in NYC

Accurate diagnosis and appropriate treatment are fundamental to resolving your heel pain. The foot pain specialists at NYDNRehab use diagnostic ultrasound and other advanced methods to correctly diagnose your heel pain. They then use cutting-edge technologies and proven strategies to rehabilitate your painful foot.

At NYDNRehab, we go beyond just treating your symptoms to resolving underlying issues. The sports medicine professionals at NYDNRehab can be counted on to give you a quick and accurate diagnosis followed by treatment protocols that eliminate the cause of your foot pain. Contact a consultation with the foot pain specialists at NYDNRehab today, and see why we are the very best rehab clinic for heel pain in NYC.

Research at NYDNRehab

About the Author

Dr. Lev Kalika is clinical director of NYDNRehab, located in Manhattan. Lev Kalika is the author of multiple medical publications and research, and an international expert in the field of rehabilitative sonography, ultrasound guided dry needling and sports medicine Dr. Kalika works with athletes, runners, dancers and mainstream clients to relieve pain, rehabilitate injuries, enhance performance and minimize the risk of injuries. His clinic features some of the most technologically advanced equipment in the world, rarely found in a private clinic.


In this instance, an athlete was originally diagnosed with minor quadriceps muscle strain and was treated for four weeks, with unsatisfactory results. When he came to our clinic, the muscle was not healing, and the patients’ muscle tissue had already begun to atrophy.

Upon examination using MSUS, we discovered that he had a full muscle thickness tear that had been overlooked by his previous provider. To mitigate damage and promote healing, surgery should have been performed immediately after the injury occurred. Because of misdiagnosis and inappropriate treatment, the patient now has permanent damage that cannot be corrected.

The most important advantage of Ultrasound over MRI imaging is its ability to zero in on the symptomatic region and obtain imaging, with active participation and feedback from the patient. Using dynamic MSUS, we can see what happens when patients contract their muscles, something that cannot be done with MRI. From a diagnostic perspective, this interaction is invaluable.

Dynamic ultrasonography examination demonstrating
the full thickness tear and already occurring muscle atrophy
due to misdiagnosis and not referring the patient
to proper diagnostic workup

Demonstration of how very small muscle defect is made and revealed
to be a complete tear with muscle contraction
under diagnostic sonography (not possible with MRI)


Complete tear of rectus femoris
with large hematoma (blood)


Separation of muscle ends due to tear elicited
on dynamic sonography examination

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