“I’ve tried everything. Why does my foot still hurt?”
It’s a question I hear almost every week.
Many patients come to my office after months—or even years—of living with chronic foot pain. They’ve changed their shoes, stretched faithfully, tried orthotics, completed physical therapy, had X-rays, and sometimes even received multiple injections.
Yet the pain persists.
Sometimes that’s because the real source of the pain hasn’t been identified.
Foot Pain Deserves Curiosity, Not Assumptions
One of the advantages of practicing in a direct-care model is having the time to look beyond the most common diagnoses.
Most heel pain is not “just heel pain.” It’s a symptom.
Our job is to discover what’s causing it.
That means asking questions, performing a thorough examination, and considering all of the structures that can produce pain—not just the most common ones.
Not Every Heel Pain Is Plantar Fasciitis
Plantar fasciitis is one of the most common causes of heel pain, but it certainly isn’t the only one.
Other possible causes include:
- Baxter’s nerve entrapment – compression of the first branch of the lateral plantar nerve that can closely mimic plantar fasciitis.
- Tarsal tunnel syndrome – compression of the posterior tibial nerve or one of its branches as it passes behind the inside of the ankle.
- Irritation or entrapment of smaller peripheral nerves throughout the foot.
- Stress fractures.
- Achilles tendon disorders.
- Heel fat pad syndrome.
- Arthritis.
- Tendon injuries.
- Inflammatory conditions affecting the joints or soft tissues.
Many of these conditions produce very similar symptoms. That’s why treating every patient as though they have plantar fasciitis doesn’t always solve the problem.
When the Problem Is a Nerve
The foot contains dozens of small nerves that provide sensation and help coordinate movement.
When one of these nerves becomes irritated, compressed, or inflamed, patients may experience:
- Burning pain
- Tingling or numbness
- Sharp, electric-like pain
- Pain that radiates into the arch or toes
- Pain that seems to “move around”
- Heel pain that hasn’t responded to traditional plantar fasciitis treatment
These symptoms can be subtle, and nerve irritation isn’t always recognized during a routine examination.
Looking Beyond Traditional Testing
At Lighthouse Foot and Ankle Center, the physical examination goes beyond simply pressing on the painful area.
In addition to a detailed history and examination, I may perform specialized clinical tests designed to evaluate whether a peripheral nerve could be contributing to your symptoms.
One examination maneuver I often incorporate is the Scratch Collapse Test. Although research continues to evaluate its role and it should not be used in isolation, I have found it to be a useful part of the overall clinical assessment when combined with a patient’s history and other examination findings.
No single test makes the diagnosis.
Instead, we combine your history, physical examination, imaging when appropriate, and your response to treatment to build the complete picture.
Sometimes the Best Test Is a Diagnostic Injection
If the examination suggests that an irritated peripheral nerve may be contributing to your pain, a carefully placed injection around that nerve can provide valuable information.
A local anesthetic such as lidocaine may temporarily quiet the nerve. If your pain improves significantly, it helps confirm that the nerve is an important source of your symptoms.
For selected patients, a small amount of dexamethasone may also be used to help reduce inflammation surrounding the nerve.
In my practice, I’ve found that carefully selected patients with suspected peripheral nerve irritation often experience meaningful improvement following targeted diagnostic and therapeutic nerve injections. While this approach isn’t appropriate for every patient with foot pain, it has helped many people who had not found relief with more traditional treatments.
Every Patient Doesn’t Need the Same Treatment
Some patients truly have plantar fasciitis.
Others have Baxter’s nerve entrapment.
Others have tarsal tunnel syndrome.
Some have a combination of mechanical overload, inflammation, and nerve irritation.
The treatment depends on the diagnosis—not the other way around.
The Right Diagnosis Changes Everything
One of the most rewarding moments in practice is seeing the look on a patient’s face when they finally understand why they’ve been hurting.
Sometimes the answer is a tendon.
Sometimes it’s a joint.
Sometimes it’s arthritis.
Sometimes it’s plantar fasciitis.
And sometimes it’s an irritated peripheral nerve that has been hiding in plain sight.
Chronic Foot Pain Deserves Curiosity
At Lighthouse Foot and Ankle Center, we believe chronic foot pain deserves curiosity—not assumptions.
Every patient has a story. Every foot is different. Every diagnosis deserves thoughtful consideration.
Taking the time to ask better questions, perform a careful examination, and look beyond the most common diagnoses often leads to better answers—and better outcomes.
If you’ve been living with chronic heel or foot pain that hasn’t responded to treatment, it may be time for a fresh perspective. Finding the right diagnosis is the first step toward finding the right treatment.
