Understanding plantar fasciitis and treating pain beneath the heel

Pain during the first steps after rest and symptoms with prolonged activity can be typical. These descriptions provide important clues, but do not replace an examination. We ask about the onset, changes in activity and previous measures, and examine the affected area. If the course is atypical, other causes of heel pain must also be considered. Imaging is not required in every case. It is used when it can answer an additional relevant question, for example if a bony cause is suspected or the course does not fit. Bring existing images and reports. You do not need to arrange an MRI yourself before an initial discussion of your symptoms.

When planning treatment, we want to know where your heel limits you most. Does your job involve standing for long periods? Is daily walking part of your independence? Would you like to manage a longer distance again? Advice that ignores your everyday life is of little help. Together, we can consider which particularly aggravating activity could temporarily be reduced or spread out differently. Well-fitting shoes that support the heel comfortably may help. Insoles can be considered in selected situations, but are not an automatic solution for every case of heel pain. Targeted stretching and strengthening exercises are selected and explained to suit you. Correct technique and an amount you can tolerate matter more than achieving as many repetitions as possible. Physiotherapy guidance can be included if needed.

Plantar fascia symptoms can be persistent. Improvement is often assessed over months; a fixed timescale cannot be predicted for an individual. It therefore makes sense to look beyond the pain on any single day. Is getting up becoming easier? Can you walk a little further? Does the foot react less sensitively after the same activity? Note changes like these and mention any marked deterioration. If a measure is not tolerated or there has been no improvement for a longer period, the plan should be reviewed. This does not automatically mean that a more invasive procedure is immediately necessary. The first step is to consider the diagnosis, how the plan has actually been put into practice and its effects so far together.

For longer-lasting symptoms, shockwave therapy may be an additional option. Whether it is useful depends, among other things, on previous treatment and medical assessment. It does not guarantee freedom from symptoms and does not replace every other measure. Treatment can be uncomfortable; possible side effects and individual risks form part of the information discussed beforehand. Special requirements apply to plantar fasciitis under German statutory health insurance. Heel pain must have restricted your usual physical activity for at least six months. Documented symptom duration and previous treatments are important for assessment; please also bring findings from other practices. During this period, different medication-based and non-medication treatments, including at least rest, stretching exercises and insoles, must have been used for a sufficient time without significant improvement. Under the guideline requirements, a maximum of three consecutive shockwave treatments per affected foot and episode of illness is provided for. We clarify with you in advance which requirements are met in your situation and how treatment can be billed. Our aim is for you to understand the next steps and their potential benefit for your everyday life. If an additional self-funded service is an option, we explain its benefits, limitations, alternatives and expected costs beforehand. You can make your decision after the discussion as well. For a service not covered by German statutory health insurance (GKV), patients with statutory health insurance receive a cost estimate in advance. We only provide this service after they have signed confirmation that they wish to receive the treatment and accept responsibility for its cost.

Painkillers may be considered depending on the situation, but must be suitable alongside pre-existing conditions and other medication. For injections, possible short-term benefit must be weighed against risks. With cortisone injections, for example, tissue damage may be a concern. An injection is therefore not indicated simply because the diagnosis is plantar fasciitis. ACP/PRP injections may also be considered for persistent symptoms. These use a preparation made from your own blood. We discuss with you what research to date can tell us about your situation, what uncertainties remain and what alternatives are available. Reliably faster healing or superiority over other procedures cannot be promised in general terms. For other advertised procedures too, it matters which evidence is available for this specific condition. An explanation of a possible mechanism of action is not yet reliable evidence of additional benefit. We want to clarify with you why a measure is being considered, what alternatives exist and how its effect can be assessed.