Question: 

I have had pain in the heel of my foot for about a year. Should I start with a general practitioner or seek out a specialist?

Answered by Alexander Sawatzke, MD, orthopaedic surgeon:

If you’ve had heel pain for a year and it’s not getting better, it’s time to see someone. Your primary care doctor is a good place to start. 

Why heel pain takes so long to resolve

Plantar fasciitis is irritation and pathologic change often at the medial insertion of the plantar fascia (the thick band of tissue on the bottom of your foot) to your heel bone. It’s one of the most common causes of heel pain and can take a long time to go away. 

About 90% of cases will resolve within a year. Many people start feeling better within three to six months, especially with treatment.

It might not be plantar fasciitis

Many people who come to see me, thinking they have plantar fasciitis, actually have something else. Other common causes of heel pain include:

• Nerve-related pain.
• Stress fractures.
• Inflammatory arthritis.
• A lack of cushion on the bottom of the heel.

A diagnosis involves a history and physical exam, including where exactly the pain is located. Plantar fasciitis frequently causes pinpoint pain on the bottom of the foot, on the inside of the heel bone. If that’s not exactly where it hurts, it often involves another condition.

Starting with your primary care doctor

For chronic heel pain, your primary care doctor can perform an evaluation as a good first step. Many primary care providers are comfortable starting treatments such as physical therapy and pain medication.

Your doctor may refer you to a foot and ankle specialist. If the heel pain is getting in the way of your daily life, you can also reach out to a specialist directly.

When to seek care sooner

You don’t have to wait a full year to get help. If your heel pain worsens or does not improve after three to six months, reach out to your doctor. The acute phase of plantar fasciitis is quite painful, so you may be able to get some treatment to help speed up the healing process.

You should also seek care right away if you experience a sudden injury to the heel or significant pain. 

The bottom line

After a year of heel pain, it’s definitely time to see a doctor. Start with your primary care provider if that feels right, or go directly to a foot and ankle specialist.