Understanding Heel Pain: A Local Sioux Falls Perspective

Dr. Lucas Marchand
Oct 11
7 min read

Updated: Oct 14

The Mystery of the Morning Stab

Janet Hendricks woke at 5:47 a.m. on a Tuesday in November, three minutes before her alarm. The bedroom was cold—Sioux Falls had seen its first hard freeze the night before—and she swung her legs out from under the quilt with the automatic movements of someone who has performed this ritual thousands of times. Her feet touched the floor. She stood.

The pain was immediate and shocking, as if she'd stepped on a nail that wasn't there. She gasped, grabbed the nightstand, and lowered herself back to the bed. Her husband stirred but didn't wake. Janet sat there, bewildered, trying to understand what had just happened to her left heel.

By the time she made it to the kitchen—walking gingerly, favoring the outside of her foot—the pain had begun to fade. By mid-morning at her job as a third-grade teacher, she'd nearly forgotten about it. But when she stood up after lunch duty, there it was again: a deep, bruising ache that made her wince.

This is how heel pain announces itself for most people. Not gradually, not with warning, but with a sudden, stabbing insistence that something has gone wrong. And for practitioners like myself who see patients struggling with this condition, the first challenge isn't treatment—it's diagnosis. Because heel pain, it turns out, is not one condition but several, each requiring its own approach.

The Usual Suspect: Plantar Fasciitis

When I examine a patient like Janet, I begin with the most common explanation: plantar fasciitis. The name refers to inflammation of the plantar fascia, a thick band of tissue that runs along the bottom of the foot from the heel to the toes. Think of it as a bowstring that supports the arch and absorbs shock with every step.

The classic presentation is unmistakable. The pain is sharp and stabbing, worst with the first steps in the morning or after prolonged sitting. It localizes to the medial heel—the inside edge, where the fascia attaches to the heel bone. Patients describe it as feeling like a stone bruise or a nail in the heel. As they walk, the fascia stretches and warms, and the pain typically improves. But after a day on their feet, the micro-tears accumulate, and the evening brings renewed discomfort.

In Sioux Falls, I see this pattern repeatedly in certain populations. Teachers like Janet, who spend hours standing on hard classroom floors. Factory workers at Smithfield. Healthcare workers at Avera or Sanford making endless rounds. Runners training along the Big Sioux River Trail, where the packed gravel seems forgiving but demands thousands of repetitive impacts. The common thread is mechanical overload: too much stress, too little recovery, and eventually the fascia rebels.

What causes this overload varies. Poor footwear is often implicated—work boots worn thin, dress shoes with no arch support, or worse, those fashion sneakers that look athletic but offer nothing substantive. Weight gain adds load to every step. Tight calf muscles alter foot mechanics, increasing tension on the fascia. Age plays a role too; the fascia loses elasticity over time, becoming more vulnerable to injury.

The Red Herring: Heel Spurs

When Janet finally came to see me, she arrived with X-rays from an urgent care visit. "The doctor said I have a heel spur," she explained, pointing to a small, hook-shaped projection of bone visible on the image. "That's what's causing the pain."

This is one of medicine's persistent myths, and I find myself correcting it weekly. Heel spurs—bony growths that develop where the plantar fascia attaches to the heel bone—are common. Studies show that roughly 10% of the population has them. But here's the crucial detail: the presence of a heel spur does not correlate with the presence of pain. Many people with prominent spurs have no symptoms whatsoever. Many people with severe plantar fasciitis have no spur at all.

The spur is a marker, not a cause. It indicates that chronic tension on the fascia has triggered bone remodeling over months or years. It's the body's attempt to reinforce a stressed attachment point. But the pain comes from inflammation and micro-tearing of the soft tissue, not from the spur itself.

I explained this to Janet, watching her face shift from confusion to relief. "So I don't need surgery to remove it?" she asked. Not unless the plantar fasciitis itself becomes severe and unresponsive to treatment—a rare outcome that I've seen in fewer than 5% of cases.

The Less Common Culprits

Not every patient with heel pain has plantar fasciitis. In Sioux Falls, where January temperatures can drop below zero and ice persists for months, I see cases of heel contusions—bruising from a single misstep on an icy sidewalk or parking lot. The pain is different: more diffuse, often worse with direct pressure than with the first steps of the morning.

Then there's fat pad atrophy, a condition more common in older adults. The fat pad beneath the heel bone naturally thins with age, reducing cushioning. Patients describe a feeling of walking on bone, a deep ache that worsens throughout the day. This is particularly common among grocery store workers, warehouse employees, and others whose jobs demand prolonged standing on concrete.

Nerve involvement presents differently still. Tarsal tunnel syndrome—compression of the posterior tibial nerve as it passes through a narrow space behind the inner ankle—causes burning or tingling that radiates into the heel and arch. Patients often report numbness or an electric-shock sensation. It's the foot's equivalent of carpal tunnel syndrome, and it's frequently misdiagnosed.

Insertional Achilles tendinopathy affects the back of the heel, where the Achilles tendon attaches. The pain is sharp with push-off, worse when climbing stairs or hills. I see this in weekend warriors who've ramped up their training too quickly, thinking the summer months offer a short window to get fit before winter returns.

And then there are the rare but serious causes: stress fractures of the calcaneus, rheumatoid arthritis, infections, or tumors. These are the diagnoses we can't afford to miss. Red flags include unrelenting pain that worsens at night, systemic symptoms like fever or unexplained weight loss, or pain that doesn't improve with rest.

The Diagnostic Process

When Janet came to my office, the X-rays had already been done. But imaging, I've learned, rarely tells the whole story. The examination does.

I had her stand and watched how she distributed weight, noting that she shifted subtly away from the painful heel. I palpated the medial heel, and she winced sharply—a classic sign. I dorsiflexed her foot, bringing her toes toward her shin, and felt the tightness in her calf. I asked her to rise onto her toes, then watched her gait as she walked across the room.

Each test added information. The palpation confirmed that the pain localized to the fascial attachment. The tight calf suggested biomechanical contribution. The painful gait showed functional impairment. Together, these findings painted a clear picture: plantar fasciitis, likely driven by prolonged standing on hard floors, compounded by unsupportive footwear and tight posterior chain muscles.

This is the art of diagnosis—not one dramatic revelation, but an accumulation of small observations that converge on truth.

What Actually Works

Treatment for plantar fasciitis requires patience, something our culture doesn't value. Patients want a pill, an injection, a quick fix. What they need is mechanical unloading and tissue remodeling, processes that take weeks to months.

I started Janet on a stretching protocol: calf stretches three times daily, and plantar fascia stretches using a towel before getting out of bed. The morning stretch is crucial—it pre-tensions the tissue before that first painful step. I recommended a night splint, a boot-like device that holds the foot in dorsiflexion during sleep, preventing the fascia from tightening overnight.

Footwear modification made an immediate difference. I sent her to a local running store where staff performed a gait analysis and fitted her with supportive shoes featuring proper arch support and cushioning. For school, she added over-the-counter orthotic inserts to her existing shoes.

Ice became part of her evening routine: rolling her foot over a frozen water bottle for 10 minutes while watching television. The cold reduced inflammation and felt, she reported, "like heaven."

Physical therapy added targeted strengthening. Weak intrinsic foot muscles can't adequately support the arch, increasing fascial strain. The therapist worked on foot and ankle stability, gradually loading the tissue to promote healing without re-injury.

For patients with more severe or persistent symptoms, there are additional tools outside of my scope. Corticosteroid injections can provide temporary relief, though a word of caution — they don't address the underlying biomechanics and carry risks of fat pad atrophy or fascial rupture if overused. Newer approaches like platelet-rich plasma (PRP) or extracorporeal shockwave therapy show promise in research, though they're expensive and not always covered by insurance.

Surgery—a fascial release or spur removal—remains the last resort, reserved for cases that fail six to twelve months of conservative treatment. In nearly twenty years of practice, I've referred fewer than a dozen patients for surgical intervention.

The Local Landscape

Sioux Falls offers robust resources for heel pain management. Avera, Sanford, Orthopedic Institute health systems both have podiatry departments with short wait times—typically two to three weeks for new patients, faster than many metropolitan areas. Some physical therapy clinics specialize in foot and ankle rehabilitation.

Local chiropractors, increasingly incorporate foot mechanics into their treatment plans, recognizing that heel pain often connects to broader kinetic chain dysfunction. A patient with plantar fasciitis may also have knee, hip, or lower back compensations that require attention.

The challenge in our region is seasonal. Winter limits outdoor activity, leading to deconditioning. Come spring, enthusiastic Sioux Falls residents hit the trails and suddenly demand their feet perform work they're not prepared for. I counsel patients to build gradually, respecting the tissue's adaptation timeline.

Janet's Outcome

Eight weeks after her initial visit, Janet returned. The morning pain had diminished to a mild stiffness that resolved within minutes. She could stand through an entire school day without the evening flare-up. She'd bought new shoes, committed to the stretching routine, and learned to listen to her body's signals.

"I thought something was really wrong," she admitted. "I thought maybe I'd need surgery or wouldn't be able to teach anymore."

This is the other cost of heel pain—not just physical discomfort but the anxiety of uncertainty. When pain appears suddenly and severely, we imagine the worst. The relief that comes from diagnosis and improvement is as much psychological as physical.

Heel pain is common, but it need not be permanent. The body, given time and proper support, has remarkable capacity to heal. The key is accurate diagnosis, evidence-based treatment, and patience—three things that, even in our hurried age, remain irreplaceable.