What causes heel pain?

Heel pain is an extremely common complaint and there are several common causes. Before any treatment can commence, it is important to get an accurate diagnosis of the cause of your symptoms. One of the most common symptoms of  is plantar fasciitis, which results in pain from walking or prolonged standing.

heel pain

What is plantar fasciitis and how is it caused?

Plantar fasciitis is heel pain as a result of irritation and inflammation of the connective tissue that reaches from the heel to the toes, supporting the muscles and arch of the foot. When this tight band of tissue (plantar fascia) is overly stretched, small tears can occur in the surface causing inflammation and pain.

Plantar fasciitis, sometimes known as jogger’s heel, is mostly caused by an injury to the plantar fascia from overuse due to running, increase in exercise routines, overweight and age-related issues.

Research has shown that the key words are overuse and wear-and-tear.

 Is there any treatment that will help to relieve this condition?

Successful treatment for heel pain depends on the cause of the problem. Before you embark on any treatment program, seek medical advice for a diagnosis of your symptoms and the severity of your condition.

Not all treatments are suitable for every circumstance, but listed below are some treatments which may be helpful in your situation, especially if diagnosed with plantar fasciitis.

  • Rest. Take a few days off jogging or exercising. It might help reduce the pain and allow the inflammation to begin to cool down.
  • Anti-inflammatory medication helps to reduce heel pain and decrease levels of inflammation.  Over-the-counter meds are efficient, but prescription options are also available from a doctor.
  • Specially made shoes or shoe inserts which provide arch support are useful to reduce pain and further injury.
  • Frequent ice pack treatment.

Are there any recommended exercises to help reduce plantar fasciitis pain?

New studies have shown that certain exercises offer remarkable benefits. They mainly involve exercising the muscles of your foot by gently stretching them as follows:

  • Towel stretch. Sit on a hard surface with your injured leg stretched out in front of you. Loop a towel around the ball of your foot and pull the towel toward you, curling your toes upward but keeping the knee straight. Hold for 20 seconds then relax. Repeat 3 times and do several times a day.
  • Plantar fascia stretch. Stand with the ball of your injured foot on a stair. Reach for the bottom stair with the heel until you feel a stretch in the arch of your foot. Hold position for 30 seconds then relax. Repeat 3 times and do several times per day.
  • Curl your toes upward while in a seated position until the arch of your foot feels tight. Hold for 30 seconds, relax, repeat 3 times, and do several times per day.

Opt for whichever exercise is most suitable for you.

 Will surgery be necessary?

Surgery is usually not needed for plantar fasciitis as most people are able to relieve the heel pain without surgery.

Your doctor could consider surgery if all avenues of non-surgical treatment have not helped and the pain is having a serious negative impact by restricting your daily activities and mobility.


Ankle pain in athlete’s

Ankle sprains can impede an athlete’s active life style.  This is seen commonly in athletes involved in cutting sports like soccer, foot ball, and lacrosse.

Last week, Chicago Bears wide receiver Brandon Marshall was very questionable to play on Sunday night against the 49ers.  He was so questionable, that numerous sports analysts reported that he was very unlikely to play. The reason for the questionable tag was ankle pain. Marshall hurt the ankle the week previously and was forced to momentarily depart from the game. He later returned but re-aggravated it in the fourth quarter. The funny thing is, not only did Marshall surprise us all by starting the game on Sunday night; he went on to score three touchdowns and lift his team to victory. Let’s take a look at what nearly prevented him from the incredible performance.

The ankle joint consists of three bones. The ankle bone (talus), the shinbone (tibia), and the small bone of the lower leg (fibula). The tibia and fibula come together to form a socket for the top portion of the talus. The bottom of the talus rests on the heelbone (calcaneus). In addition to the bones of the ankle, there is a set of ligaments that work in tandem with these bones in order to support the lower leg and ankle. In addition to bones and ligaments there is a set of tendons that connect the lower leg muscles with the ankle and foot. Just like a machine with moving parts, if any of these parts is hindered or working incorrectly, there can be ankle pain.


Ankle Ligaments
Ankle Impegiments

While there was no specific diagnosis of Brandon Marshall’s ankle, let’s take a look at the potential causes of his ankle pain. There are many things that can cause ankle pain. Tendinitis, arthritis, gout, infection, fractures, sprains, and bruises are the most common causes of ankle pain.

We can probably rule out things such as tendinitis and arthritis. These can be very painful and occur when there is inflammation to the tendons and joints respectively. These issues typically are long lasting and take time to develop. Similarly issues like gout and infection can be ruled out because these would not be caused by an in-game injury. Gout is caused when there is a high build-up of uric acid, which leaves crystalline deposits in the joints.

That leaves us with fractures, sprains, and bruises. A fracture would require a break in one of the bones that make up the ankle. It is possible that a hairline fracture could go un-noticed if there is not a proper a battery of tests conducted. However, even a hairline fracture would probably cause a substantial amount of pain and a good bit of instability, making it hard to play.  Ankle sprains involve tears of the ligaments in the ankle. It is possible that Marhsall had a very minimally sprained ankle, perhaps, just a couple of microscopic tears within the lower ligaments of the ankle. Between supporting the ankle and pain-management, Marshall could in fact play with a minimally sprained ankle. Lastly there could be simple bruising of the ankle due to in-game contact. This would cause some pain and discomfort but could be played through if managed correctly. Even the most minimal of ankle sprains or fractures are very unlikely to slip past the NFL’s strict injury reporting policies, so for my money, I’d chalk this up to just a simple bruised ankle. Whatever you believe was the cause of Marshall’s ankle pain; he played through it and performed substantially better than expected. No reason to believe that this upcoming week will be any different.

If you have any questions about your ankle pain, contact our award winning sports medicine specialists at San Diego Orthopedic Surgery clinic to receive guidance.

Ankle Pain In Athletes


Jamaal_Charles_ankle-sprainIf you are wondering why your fantasy-football playing coworkers are spending their lunch breaks hitting their heads against the lunchroom table, your answer lies ahead. Kansas City Chiefs running back Jamaal Charles left Sunday’s game early in the first quarter. Jamaal Charles is arguably the best running back in the NFL and he was a top 5 fantasy football pick in virtually every draft this year. The good news is Jamaal Charles season is not in doubt; the bad news is that he will likely miss a few weeks. It turns out Jamaal Charles suffered a high ankle sprain.


Ankle sprain is very common injury and can happen during athletics, but can also happen during simple, everyday tasks. You could be walking the dog and step on an uneven surface. You could be heading home from a night at the theater and your heel could collapse underneath you. Literally, there are about a thousand different ways you could sprain your ankle. The cause of an ankle sprain is typically due to a twisting, rolling, or turning of the foot. These movements are by no means abnormal and usually the ankle ligaments naturally stretch and then revert back to normal position. However, if the motion causes the ligament to stretch beyond their normal range, than an ankle sprain can occur.lateral-ankle-sprain-injury

Ankle sprains is diagnosed by severity of the sprain. Grade I ankle sprains are very minimal and consist of only microscopic tearing of ligament fibers. There may be some pain, swelling and tenderness, but range of motion is minimally affected and ankle can typically still bear full weight. Grade II ankle sprains are moderate and consist of complete tears of some of the ligament fibers.  There is likely pain, swelling, tenderness, bruising, decreased range of motion, and instability associated with a grade II ankle sprain. Grade III ankle sprains are severe and consist of a complete rupture of the ligament. A grade III sprain will cause severe pain, swelling, tenderness, bruising, decreased range of motion, and instability. In addition to the severity of the sprain, the location can also have an impact on the diagnosis and the prognosis. The high ankle sprain is the worst of the ligament sprains because it involves the set of ligaments that lie above the ankle. These ligaments act as a shock absorber between the tibia and fibula. Compared to the lower ankle ligaments, the higher ankle ligaments are placed under significantly more force while walking, running, jumping, and cutting.


Ankle Sprain Recovery

Recovery from an ankle sprain does not typically require surgery and occurs in three phases: resting and protection, restoration and strengthening, and gradual return to normal activity. The recovery time is dependent upon the severity and the location of the ankle sprain. Grade I sprains typically take 1-3 weeks. Grade II sprains typically take 3-6 weeks. Grade III sprains can take anywhere from 6-12 weeks.  A high ankle sprain can typically take twice as long to return to form. There has yet to be a timeline released for Jamaal Charles’ return, but the initial diagnosis is a non-severe high ankle sprain; likely somewhere between a grade I and grade II ankle sprain. So while this is a pretty huge loss for Charles, the Chiefs, and all you fantasy football owners out there, there is a very good chance he returns by mid-season and if he recovers fully he should make a huge impact for the playoff push.


If you need help recovering from an ankle injury, contact our award winning sports medicine doctors at San Diego Orthopedic Surgery today.


© 2023 Dr. Robert Afra – San Diego Orthopedic Surgery Shoulder – Knee – Elbow