plantar fasciitis

YOUR FIRST STOP FOR HEEL PAIN in San Antonio & South Texas

PLANTAR FASCIITIS Frequently Asked Questions

If you suffer from heel or arch pain in your feet,you probably start your day like many others with the same pain—convincing yourself to “get it over with” and to put your feet on the floor for the first time that morning.

This is often when pain is the worst for those suffering with chronic foot pain, and many people have simply accepted that this is now part of their morning routine.

Plantar fasciitis, a condition also known as heel spur syndrome, is an inflammation of the plantar fascia—a band of tissue that runs from your heel to your toes. This inflammation is typically caused by an abnormality in the structure of the foot, such as extremely high arches or flat feet—or by an external irritation, such as non-supportive footwear over long periods of time.

The ligament supporting your arch swells and tightens on a regular, daily basis. If your ligament becomes overworked or strained, you feel pain in your heel known as plantar fasciitis. Continuing to use your foot after swelling of your ligament causes small microtears, increasing injury further.


Plantar Fasciitis Specialist

heel spur is a bone-growth that looks like a spur at the insertion of the plantar fascia on the heel. They’re seen more frequently in people with painful heels but they are also seen quite frequently in people that have no pain. The presence or absence of a heel spur does not make the diagnosis of plantar fasciitis but does suggest the presence of the disease. The spur does not (usually) need to be removed to alleviate heel pain. Many many people live their whole lives with heel spurs with no pain in their heels.


When you get out of bed in the morning, are your feet sore and stiff? This often occurs with inflammation of the ligament in your foot directly causing plantar fasciitis. The causes of plantar fasciitis include:

  • Poor workout routines
  • Overuse injuries
  • Weight gain
  • Tight Achilles tendons
  • Low or falling arches
  • Poorly fitting shoes
  • Sudden changes in exercise

With so many reasons for your plantar fasciitis, speak with a healthcare professional about your specific cause and how you can prevent future inflammations.

About 2 million people every year receive a plantar fasciitis diagnosis. It’s the most common cause of pain in the heel, but luckily, the condition is easy to manage with correct treatment and early detection.

Your podiatrist uses different physical tests and diagnostic images when diagnosing plantar fasciitis. Plantar fasciitis is most common in long-distance runners, people who stand a lot, and overweight people.

There are several clues that help to make the diagnosis of plantar fasciitis (PF) as opposed to the other causes of heel pain.  They are not 100% but taken together they do help.

1: Location of pain:  PF usually hurts on the plantar medial aspect of the heel. This  is on the inside of the heel.  Pain can also extend into the arch.  If the whole bottom of the foot is sore it may be something else. 

2: Timing of pain:  PF usually hurts more the first steps of the morning as you get out of bed. It also usually does not hurt when you get off your foot.  If you have pain after laying down that lasts for more than a few minutes it is more likely to be nerve pain. 

3: Relief with a few steps.  In the early stages of plantar fasciitis the pain subsides after being of the feet for a few minutes.  As the tissues get stretched and warmed up the pain decreases.  When it gets more severe the pain persists.

Short answer, yes! One of the most common childhood complaints, heel pain is often caused by Sever’s disease. Sever’s disease is the result of the growth plates in the heel growing faster than the Achilles tendon, which causes irritation and pain as the tendon and other muscles tighten. Dr. Silvester can help treat symptoms effectively and economically with shoe inserts and therapy.

Learn more:Sever’s Disease and Heel Pain

Children suffer from many other foot conditions, if your child complains about their feet “being tired” or hurting, please visit our Pediatric Foot Care page to learn more.  

As with all conditions, heel pain is much easier to treat when it is caught early.  If you have had pain for 4-6 weeks  get an appointment with a good foot doctor (we like us) :).  Most of our heel pain patients are 80% improved in one week after seeing us.  They might not be cured but they sure feel better.  Healing the damaged tissue takes time.  If you have had heel pain for  one year it is going to take more effort than if you have had it for one month.   

If you have had heel pain that won’t go away  for 3-6 months then surgery is a consideration. There are other considerations of course. These include the severity of the pain, contributing factors, associated diagnoses and  the overall health of the patient, social factors etc.

Heel pain surgery fails for two reasons most of the time:

  1. Failure to make the correct diagnosis
  2. failure to address all the problems that are causing the heel pain.

Frequently nerve pain is involved and the doctor has not even looked at that possibility.

A short Achilles tendon should also be addressed. But, if these factors are addressed during the surgery the success rate is usually very high.

Of course, there can be other reasons for failure but these are the most common.    

1:  Get some good running shoes with a thick heel cushion. Try and wear them most of the time.  Avoid barefoot on hard surfaces.  

2: Get good arch supports if you have a normal foot. (We sell some great ones at our office for heel pain).  Don’t spend  more than 50 dollars. STAY AWAY FROM RETAIL “ORTHOTICS” THAT ARE JUST OVER THE COUNTER ARCH SUPPORTS AND COST HUNDREDS OF DOLLARS.  

3: Stretch your achilles tendon gently 2 minutes three or four times a day for 2 minutes. There are lots of ways to do this.  Look on line. Plantar Fasciitis Specialist

4:  Stretch your plantar fascia frequently. Don’t over do this. You can aggravate the problem with too aggressive stretching. 

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treatment options

If you truly have plantar fasciitis that’s all you have, we have a wonderful treatment plan that usually can get you feeling better fairly quickly (a few days). We follow that up with long-term plan to heal the damaged tissue.  This is all determined by how you are doing with our therapies. On your first visit our goal is to have you 85-90% better in 2-5 days.

To do that we do several things all at once. This approach has been very successful for our patients. Most of the things mentioned above are in that plan. We also include medications, injections, night splints, and nutritional supplements.

We have an array of therapies not available in most clinics if needed.   First, your ligament needs to heal. Your podiatrist may suggest reducing your activity level or taking a break from activities for a short time. Elevating and icing your foot also help reduce the swelling.


Treatments for plantar fasciitis can vary depending on the severity and nature of your inflammation. Sometimes, simple at-home options such as stretches, ice packs, and shoe modifications can help reduce irritation, and are often initially prescribed to reduce pain and symptoms. If the pain continues, more aggressive treatments such as night splints and casts, injections, or orthotics are employed.

The professional team at Next Step Foot & Ankle Center helps you determine the best way to alleviate plantar fasciitis, in the most conservative way as possible.

Most cases of plantar fasciitis go away after treatment methods such as:



Changing your shoes to more comfortable footwear and/or adding orthotic insoles to relieve the pressure on your ligament can help increase your elasticity and heal.





Click the video below to see how Dr. Silvester recommends stretches to help treat your Heel Pain. Stretching helps loosen your ligaments, increasing the elasticity and helping them heal.



Wearing a night splint or brace keeps your muscles from pulling on your bone while you sleep, assisting further in helping you heal.

In studies it works to treat Plantar Fasciitis about 65% of the time without doing anything else. 


Dr. Silvester and Dr. Larsen specialize in many advanced minimally and non-invasive treatments, and if necessary, advanced minimally invasive and traditional surgical techniques with patient proven success stories. Sometimes combining these modalities can magnify the effects.

Some of those modalities are used to treat your Plantar Fasciitis, such as:

  • Diagnostic Injections
  • Shockwave Therapy
  • Nerve Decompressioin
  • Tendon Lengthening
  • AmnioFix Injections
  • Custom Orthotics
  • Minimally Invasive Surgery
  • MLS Laser Therapy
  • In-office diagnostics with our ultra sound device
  • CryoSurgery

Shockwave therapy if appropriately applied has been shown to be as effective as surgery. It does not interrupt your activities of daily living, has a very quick results in general, and can help  induce long-term healing to the tissues. Shock wave has been shown to be as effective as surgery for plantar fasciitis. 

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Nerve Decompression Surgery

When other non-operative treatments fail and compression of the nerve is playing a role in the nerve dysfunction, surgery may be the best option. Sometimes nerve disease is like sleeping on your elbow wrong. You wake up and your hand is numb or tingling. The nerve is just always being compressed.

Nerve decompression surgery allows the surgeon to open the tight area through which the nerves pass by dividing the anatomical structures that encase the nerve. Surgical procedures can be performed in the comfort of our Olympia Surgery Center.

Dr. Silvester and Dr. Larsen have additional certifications in nerve surgery. He has undergone specialized training in the treatment of painful nerve conditions. The organization called The Association of Extremity Nerve Surgeons (AENS) provides advanced training in the medical, physiological, and surgical treatment of nerve conditions. Through this organization and other ongoing medical education, Dr. Silvester chose to specialize in the treatment of these difficult and perplexing conditions. Dr. Silvester achieved adequate surgical experience and demonstrated proficiency in the procedure, and is now a Fellow of the Association of Extremity Nerve Surgeons.

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Frequently if the heel pain has been present for a long time or is significant degeneration in the ligament (plantar fascia). This treatment can provide a structural repair model for the tissue to heal itself.

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This is often used in conjunction with shockwave therapy.

Also, we occasionally use amnion injections to help tissue heal.

Almost every podiatrist does orthotics. Unfortunately, the vast majority of orthotics dispensed are nothing more than expensive arch supports and do not take into consideration what the patient’s foot is like.

We do a good exam so when you get your orthotic it really controls your foot and decreases stress on the plantar fascia. We have the most advanced digitized foot scan and dynamic pressure plate analysis platform commercially available. 

Click the link to learn more about the FitStation by Hewlett Packard.

Sometimes, nothing else works so surgery is necessary.  We use many different types of surgical approaches to heel pain one of them that is very helpful is a percutaneous procedure where the incision is about as wide as a pencil lead.  This results in a very quick return to work and activity.

There are very minimally invasive procedures available for chronic plantar fasciitis. These require an incision that is about the width of  a pencil.  These can be done endoscopically or with the use of an ultrasound. The success rate of this kind of surgery is about 90%.
There are also more traditional open procedures.  These require a much longer recovery.
These surgeries can be combined with some of the advanced therapies listed above to speed the recovery and increase the success of the surgery.

In general, If we perform surgery on heel pain we use these minimally invasive techniques 1st.

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We have the gold standard in laser therapy.  It is a robotic computerized laser that provides multiple benefits: Anti-inflammatory, analgesic, accelerated tissue repair, and improved vascularity are just a few.

Click the link to learn more about our MLS Laser Therapy and all it's benefits. 

If you suffer from persistent heel pain that hasn't responded to other treatment methods, cryosurgery may be right for you. Dr. Darren Silvester, podiatrist in Pleasanton, TX, offers minimally invasive cryosurgery to treat heel pain.

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Why choose us to treat your heel pain with Plantar Fasciitis?

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Click the video to hear from Dr. Silvester direct on why we provide the best care for heel pain caused by plantar fasciitis. Let us help you!


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