What heel and tendon pain usually means
Tendons and the thick bands of tissue that support your arches are built to take load, but they repair slowly. When the load outpaces the repair, the tissue thickens, becomes tender and starts to hurt with every step or grip. That pattern shows up in a handful of familiar places.
- Plantar fasciitis. Sharp pain under the heel, worst with the first steps in the morning or after sitting, easing as you warm up and returning by evening. It is the most common cause of heel pain and is often blamed on a "heel spur" that is really just a sign of long-standing strain.
- Achilles tendon pain. Pain and stiffness at the back of the heel or a few inches above it, worse with stairs, hills and running. The tendon may be thickened and tender to squeeze.
- Tennis elbow and golfer's elbow. Pain at the bony points on the outside or inside of the elbow with gripping, lifting a kettle, or turning a door handle. Common in tradespeople and anyone who works with their hands.
- Other tendon pain. The patellar tendon below the kneecap, the hip tendons on the outside of the hip, and the tendons around the shoulder all develop the same slow, aching, activity-related pain.
These problems are rarely dangerous, but they are stubborn. Rest and stretching help some people. Many are still limping a year later, which is where a pain physician comes in.
How our doctors treat it
The consultation starts with an exam of the painful tendon or heel and the joints around it, and a look at how you walk or move. Ultrasound in the exam room shows tendon thickening, small tears and fluid, so we know what we are treating. Depending on what we find, the plan may include:
- StemWave shockwave therapy. Focused acoustic waves are delivered through the skin to the painful tendon or fascia in sessions of around ten minutes, with no needles, no medication and no downtime. Shockwave has been used for plantar fasciitis and tendon pain for years and is our lead treatment for these conditions. Most patients have a series of sessions over several weeks. It is available at our Davie clinic as a cash service, and new patients can try an introductory session for $49.
- PRP injections. Platelet-rich plasma from your own blood is injected under ultrasound guidance into the damaged tendon or fascia to support its repair. An option for patients who have not responded to shockwave or who prefer a single treatment. PRP is a cash service, offered at both clinics.
- Steroid injections. A guided corticosteroid injection can calm severe plantar fasciitis or elbow pain quickly. The doctor uses these sparingly, because repeated steroid injections can weaken a tendon, and never into the Achilles itself.
- Medication, footwear advice, night splints and a stretching program alongside any of the above.
Does insurance cover it? Consultations, ultrasound and steroid injections are covered by Medicare, Aetna, Blue Cross Blue Shield and Cigna when medically necessary. StemWave shockwave therapy and PRP are cash services and are not covered by insurance. The front desk will explain the cost of a treatment course before you commit to anything. Read more about insurance and self-pay.
What to expect
- Before you come in, we verify your insurance for the consultation and ask you to bring photo ID, your medication list and any imaging or podiatry records.
- At the consultation, the doctor examines the heel or tendon, scans it with ultrasound and explains what is going on and which treatment fits.
- Treatment starts. Shockwave sessions at Davie are short and you walk out afterward. If PRP or a steroid injection is chosen, it is done under ultrasound guidance in the exam room.
- Follow-up checks your progress at the end of the shockwave series or a few weeks after an injection, and the plan is adjusted from there.
What shockwave feels like
The applicator is held against the skin over the painful spot and delivers rapid pulses. Most patients describe it as a firm tapping that is uncomfortable over the sore area but easily tolerated, and the discomfort fades as the session goes on. There is no anesthetic and no recovery period. Some soreness for a day or two is normal. Results build over the course of treatment, and many patients notice the morning pain easing before the series is finished. Results vary, and the doctor will tell you honestly whether your tendon is a good candidate.
Is StemWave available at Boynton Beach?
No. StemWave shockwave therapy is offered at our Davie clinic only. Boynton Beach patients can be seen at Boynton Beach for the consultation, injections and PRP, and travel to Davie for shockwave sessions if that is the right treatment.
How many shockwave sessions will I need?
Most patients have a series over several weeks, spaced about a week apart. The doctor sets the number after examining you and reviews progress at the end of the series.
Does shockwave therapy hurt?
It is uncomfortable rather than painful, and the intensity is adjusted to what you can tolerate. Sessions are short and you can drive and walk normally afterward.
Is shockwave covered by insurance?
No. It is a self-pay service. Your consultation and any steroid injections are billed to insurance as usual. The clinic will explain the cost of a course before you start.
Should I stop walking or exercising?
Not completely. Reducing the activities that flare the pain helps, but total rest tends to make tendons weaker. The doctor will give you specific guidance on footwear, stretching and loading based on your job and your goals.