Plantar Fasciitis Case Study: Nerve Block for Heel Pain

This case at a glance

 

Presenting Complaint

A woman in her 60s presented with pain in her right heel. The pain was sharp the moment her foot touched the floor each morning. It was bad enough to make her limp.

After she walked for a while, the sharp pain eased into a dull ache. Standing up after sitting for a long time brought the sharp pain back. Walking for a long time also left her foot sore.

She had seen several doctors before. Some said she had plantar fasciitis, and others said a heel spur (a small bony growth on the heel bone) was the cause. Injections into her foot had eased the pain for a short time only.

Insoles and new shoes had not helped either. She had become afraid to walk, because both standing and walking set off the heel pain.

Diagnostic Findings

Her pain followed a clear pattern. It was worst with the first steps after rest, eased as she moved, and came back with long standing or walking. I recognised this as the typical pattern of plantar fasciitis.

The plantar fascia is the thick band of tissue under the foot. It runs from the heel to the toes and supports the arch. During sleep or rest, this tissue tightens up.

The first steps stretch the tight tissue, and that hurts. Once the heel loosens, the pain usually settles, until long standing or walking strains it again. No scan results are recorded for this case, so I based the diagnosis on her symptoms and history.

Why This Approach

She had already tried insoles, new shoes and injections into the foot. The injections had only helped for a short time. I chose a nerve block because it can help the tight fascia relax and improve blood flow to the area, which supports repair. I paired it with physiotherapy to work on the foot after the injection.

Treatment Approach

1. I injected local anaesthetic (numbing medicine) around the nerves of her plantar fascia, to keep her comfortable during treatment.
2. I gave a nerve block: an injection near the nerves that supply the heel, to help the tight tissue relax and improve blood flow.
3. I then arranged a course of physiotherapy for her foot.

Outcome

In this case, her heel pain had resolved after 3 physiotherapy sessions. At the time the case was recorded, the pain had not come back.

What This Case Shows and Doesn’t Show

This case shows how plantar fasciitis was managed in one patient. It does not show that a nerve block will work for everyone, and results vary between patients.

Heel pain can have other causes, such as a stress fracture, a trapped nerve or arthritis, so these need to be checked first. Many people start with simpler care, such as stretching and better footwear, and a nerve block may not suit everyone.

Ask the Doctor

Who is more likely to get plantar fasciitis?

Plantar fasciitis is most common in middle-aged men and women, but it can happen at any age. It is sometimes linked to putting on weight quickly. I also see it in people who run for leisure. Research suggests that a sudden stretch or strain on the heel can damage the tough tissue of the arch.

Is my heel pain caused by a heel spur or plantar fasciitis?

The two are often confused, by patients and sometimes by doctors. A heel spur is a small bony growth on the heel bone that can show up on an X-ray. Plantar fasciitis is a strain of the thick band of tissue under the foot. A typical sign is sharp heel pain with the first steps in the morning that eases as you keep walking. A spur on an X-ray does not on its own tell me it is causing the pain. So I look at the whole pattern of your symptoms.

How can I stop plantar fasciitis from coming back?

After treatment, keep doing stretches that loosen the tissue around the heel bone. These simple exercises help keep the foot flexible. They also help lower the chance of plantar fasciitis coming back.

 

This case describes one patient’s experience under specialist care. Individual results vary, and it is not a substitute for a personal medical assessment.