Heel pain that has outlasted rest, orthotics, and stretching is a loading problem with an inflammation name. Dr. Cisneros combines dry needling of the calf and foot with the heavy-slow loading program the evidence actually supports — one-on-one, the full hour, every visit.
Not all heel pain is plantar fasciitis. The evaluation sorts out which of these you have, because the loading, the needling targets, and the timeline are different for each.
Sharp pain under the heel with the first steps out of bed or after sitting, easing after a few minutes. The classic plantar fasciitis presentation, and the one that responds best to loading.
Heel or arch pain that came on with a jump in mileage, a new shoe, or a training block. A load problem — the fix is calf and hip capacity plus a controlled running dose, not six weeks off.
Nurses, teachers, warehouse and retail workers: hours on hard floors with no chance to rest the tissue. Loading, footwear, and calf work together, built around a shift you cannot change.
Burning, tingling or numbness along the inside of the heel points to nerve entrapment (Baxter’s nerve) or a low-back source rather than the fascia. Treated with neural work and needling, not fascia loading.
Pain at the back of the heel or up into the calf, often alongside the plantar symptoms. The calf and fascia share load; both get rebuilt, and Achilles tendinopathy has its own loading rules. See our Achilles page →
A year or more in, one or more cortisone shots, orthotics in every shoe, and no lasting change. The tissue has adapted; the program is slower, heavier, and it still works.
Each starts with a diagnosis of which structure is overloaded and why, then a loading program built around it. Dry needling and manual therapy support that plan; they are not the plan.
Plantar fasciitis is a load problem with an inflammation name. Dr. Cisneros rebuilds the capacity of the fascia and the calf while needling and manual work make that loading tolerable.
Ankle mobility, calf strength and length, foot intrinsic strength, hip control, footwear, and the training or work change that started it. The heel is where it hurts; the cause is usually somewhere along that chain.
Progressive calf raises with the toes elevated so the fascia is tensioned as the calf loads, three seconds up and three down, every other day, progressed with weight. This is the exercise the evidence supports most, and it is done properly, with a starting load set from your evaluation.
Needling of the gastrocnemius, soleus, and plantar foot trigger points that hold the fascia under tension, including electrical dry needling for stubborn or long-standing cases, plus ankle and foot joint mobilization. Pain relief that makes the loading possible.
A controlled running or standing dose the heel tolerates, footwear and short-term support where they help, and a return to full volume built on the strength gained — not on six weeks of rest that restarts the problem on the first day back.
Overload of the plantar fascia where it attaches to the heel, usually after a change the tissue was not ready for — a jump in running or standing time, new shoes, a heavier training block, or weight gain. Tight calves, a stiff ankle, and weak foot and hip muscles all push more load onto the fascia. It is a loading problem more than an inflammation problem, which is why rest alone so rarely fixes it.
Overnight the fascia shortens and the irritated tissue stiffens; the first steps stretch it suddenly under full body weight. That sharp first-step pain that eases after a few minutes is the classic sign. Pain that is worse at the end of the day, or numbness and burning, points to something else — heel fat pad irritation, a nerve entrapment, or an Achilles problem — which is why the evaluation matters before the treatment.
Yes, as part of a plan. Trigger points in the calf (gastrocnemius and soleus) and in the small muscles of the foot keep the fascia under constant tension; needling them, including with electrical stimulation, reduces that tension and pain quickly. What it does not do is rebuild the capacity of the fascia — that comes from the loading program. Dr. Cisneros uses needling to make the loading tolerable, not instead of it.
Heavy, slow calf raises with the toes propped up on a rolled towel — so the fascia is tensioned while the calf loads — are the single most-supported exercise, done every other day and progressed with weight. Around that: calf stretching, plantar fascia stretching before the first steps, foot intrinsic strengthening, and hip strength for runners. Dr. Cisneros sets the starting load from your evaluation and progresses it as the heel settles.
Most people feel a real change in 4–6 weeks and are back to full activity in 8–12, when the loading is consistent. Cases that have been going for a year or more take longer because the tissue has changed, but they still respond. What stalls recovery is stopping the program the week the pain eases.
Usually not first. An injection can quiet the pain for a few weeks, but it does not change the load that caused it, and repeated corticosteroid injections carry a small risk of fascia rupture and fat pad thinning. Loading and needling address the cause; an injection is a reasonable conversation with your physician if a proper rehab course has genuinely failed.
Often yes, at a reduced and controlled volume — complete rest tends to deload the tissue and then reload it too fast. Dr. Cisneros sets a running dose the heel tolerates (pain that settles within 24 hours is the usual rule), fixes the calf and hip strength that offloads the fascia, and builds the volume back up. Runners who stop completely for six weeks often restart the injury on day one back.
The evaluation rules out the look-alikes: heel fat pad syndrome (central heel pain, worse barefoot on hard floors), Baxter’s nerve entrapment (burning or numbness along the inside of the heel), Achilles tendinopathy (pain at the back of the heel), calcaneal stress fracture (pain with squeezing the heel from the sides), and referred pain from the low back. Each is treated differently, and a program aimed at the wrong one does not work.
No. Texas is a direct access state — you can see a licensed physical therapist for plantar fasciitis without a doctor’s referral. At Solas PT in El Paso you can start without a referral or prior authorization; Texas direct access covers the first 30 consecutive calendar days, and a referral is only needed if care continues past that. Most heel-pain plans finish within that window.
Solas Physical Therapy is a top-rated choice for plantar fasciitis and heel pain in El Paso, holding a 5.0-star rating across 36 Google reviews. Dr. Andrew Cisneros, PT, DPT, MS is a certified dry needling specialist who combines calf and foot needling — including electrical dry needling for stubborn cases — with the heavy-slow loading program that rebuilds the fascia, in a full one-on-one hour every session. Solas PT is cash-based and direct-access at 300 N Resler Dr, Ste F in west El Paso.
Same-week appointments available. No referral needed. One-on-one with Dr. Cisneros every session.
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