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Main causes of foot pain
The foot is a complex structure of 26 bones, 33 joints and more than 100 ligaments. So there are many possible sources of pain. A diagnosis is made after ultrasound and MRI.
Plantar fasciitis / "heel spur"
Inflammation and microtears of the plantar aponeurosis. Typical complaint — sharp pain under the heel with the first morning steps, which eases after walking but returns by evening. The X-ray spur is an incidental finding, not the cause of pain.
Achilles tendinopathy
Tendinopathy of the Achilles tendon. Pain and thickening above the heel, morning stiffness, limited dorsiflexion. Typical for runners, with overload, and in middle age.
Ankle arthrosis
Usually post-traumatic — after ankle fractures and chronic instability. Pain on loading, stiffness, crepitus, restricted range of motion.
Metatarsalgia
Forefoot pain under the metatarsal heads. Sensation of a "pebble" or "sock fold." Associated with overload, deformities (hallux valgus), arch changes.
Morton's neuroma
Thickening of an interdigital nerve. Burning, shooting pain and numbness between the 3rd and 4th toes, especially in narrow shoes. Hypoechoic mass on ultrasound.
Hallux valgus and hallux rigidus
Deformity and arthrosis of the first metatarsophalangeal joint. Pain on walking, restricted big toe extension, "bunion." regenerative treatment started early slows progression.
Pain in the heel
Plantar fasciitis
Classic complaint: "first steps in the morning — like walking on nails." Pain under the heel, worsens after prolonged standing. Confirmed by ultrasound — aponeurosis thickening over 4 mm.
Achilles tendinopathy
Pain behind and above the heel, in the Achilles zone. Typical thickening of the tendon 2–6 cm from its insertion. Ultrasound — hypoechoic areas and neovascularization.
Regenerative treatment
Ultrasound-guided CGF or PRP precisely into the zone of maximum degeneration. 2–3 sessions with a 2–4-week interval. Return to activity in 2–6 weeks. Surgical fasciotomy becomes unnecessary in most cases.
Pain in the ankle
Most frequent diagnoses: post-traumatic arthrosis, osteochondral talar lesions, tendinitis around the ankle, chronic instability.
Cartilage regeneration
Cells and growth factors mainly reduce inflammation and may support tissue healing; how much the tissue recovers cannot be predicted in advance. An alternative to arthrodesis and endoprosthesis.
Focal chondral defects
Osteochondral lesions of the talus (OCD) often require combination with microfracture or AMIC. Regenerative treatment boosts the biological response.
Tendinitis
Posterior tibial, peroneal, anterior tibial — all respond to ultrasound-guided CGF/PRP injections.
Forefoot and midfoot
Metatarsalgia, Morton's neuroma, arthrosis of the naviculo-cuneiform joint — all follow the same treatment principle: a precisely targeted ultrasound-guided injection. In Morton's neuroma, regenerative methods often avoids neurectomy (nerve removal), preserving toe sensation.
How it is treated: the cause comes first
Treatment depends on the cause of the pain, so it starts with an examination and, if needed, imaging — X-ray, ultrasound or MRI. The same pain can be caused by osteoarthritis or by a tendon, nerve or disc problem.
Most patients are helped by conservative treatment: exercise therapy, load management, short courses of painkillers and sometimes injections. Regenerative methods (PRP, cell preparations) are discussed once the diagnosis is known and there is at least limited evidence for it; no method guarantees a result.
We send a description of your case and your images to several partner clinics. The clinic doctors give a preliminary opinion, suggest a plan and quote a price, and we help you compare the options.
Who it is not suitable for and possible risks
Contraindications
- Active infection — at the injection site or systemic, with fever.
- Active cancer or ongoing chemotherapy.
- Blood clotting disorders or a low platelet count. Anticoagulants are discussed with the physician.
- Pregnancy and breastfeeding — the procedure is usually postponed.
- A corticosteroid injection into the same area in recent weeks.
- A complete tendon or ligament rupture with loss of function — surgical repair is usually needed.
Possible risks
- Pain and swelling at the injection site for 1–3 days.
- Bruising where blood or fat tissue is taken.
- Rarely, infection. The procedure is therefore performed under sterile conditions with ultrasound or X-ray guidance.
- The effect may be absent or smaller than expected.
If any of these apply to you, mention it in your request. The coordinator will check with the clinic physician whether treatment is possible. Contact a coordinator.
Scientific evidence
Studies of regenerative methods show mixed results. Clinic physicians rely on research including the following:
- Monto RR. Platelet-rich plasma and plantar fasciitis. Sports Med Arthrosc Rev, 2013.
- Sheth U et al. Efficacy of autologous platelet-rich plasma use for orthopaedic indications: a meta-analysis. J Bone Joint Surg Am, 2012.
Next steps: Treatment methods · Treatment cost · How treatment in Germany is organised
Frequently asked questions
Heel pain with the first steps in the morning is a typical sign of plantar fasciitis. The basis of treatment is stretching the fascia and calf muscles, suitable footwear and insoles; for chronic pain shockwave therapy helps, and injections help some patients.
A “spur” is a bony outgrowth seen on X-ray; it does not hurt by itself and is found in many people without pain. The inflamed plantar fascia next to it is what hurts, so treatment targets the fascia, not the spur.
In early stages usually not: footwear, a brace, exercise, weight loss and injections during flare-ups help. With severe pain and joint destruction, ankle fusion or ankle replacement is discussed; the clinic physician decides based on the images.
Yes, but gradually and without pain. Timelines depend on the diagnosis: after fasciitis or tendinopathy, return to running usually takes several months. Start with walking and short intervals, increasing volume by no more than 10% a week.
The basis of treating Achilles tendinopathy is calf strengthening exercise for 12 weeks or longer. Shockwave therapy and PRP help some patients as an add-on. Corticosteroids are not injected into the Achilles tendon.