OrthoBethesda
10215 Fernwood Road, Suite 506Bethesda, MD 20817(301) 530-1010
Ankle & Foot Specialist
Ankle & foot specialist — Achilles & plantar fasciitis
The short answer
Dr. Gruner treats Achilles tendinopathy and plantar fasciopathy (heel pain) with progressive loading programs, orthotics, and physical therapy — plus ultrasound-guided PRP, Tenex, and tendon scraping for stubborn cases — helping runners and active people get back on their feet without surgery.
Medically reviewed by Marc Gruner, DO, MBA, RMSK
Sports medicine physician, Mayo Clinic fellowship. Last reviewed June 2026
Foot and ankle pain — most commonly Achilles tendinopathy and plantar fasciopathy — usually comes from overuse and micro-damage rather than simple inflammation, which is why rest alone often isn't enough.
Dr. Gruner combines targeted loading programs, footwear and gait strategies, and physical therapy with ultrasound-guided options such as PRP, percutaneous tenotomy (Tenex), and tendon scraping for chronic cases — getting runners and active people back to their activities.
What is ankle and foot pain?
The foot and ankle carry your entire body weight over thousands of steps a day, so overuse injuries are common — especially in runners and active adults. The two problems Dr. Gruner treats most are Achilles tendinopathy (pain in the back of the heel or lower calf) and plantar fasciopathy (heel pain that's worst with the first steps in the morning). Ankle arthritis, peroneal tendon problems, and nerve issues can also cause foot and ankle pain.
These conditions typically build gradually and are stubborn precisely because they reflect tendon and fascia degeneration rather than short-term inflammation.
What causes Achilles and heel pain?
Both are overuse injuries: repetitive loading causes micro-damage that outpaces the body's repair, leading to tendon and fascia degeneration. Rapid increases in running mileage, footwear changes, calf tightness, and biomechanics all contribute.
How is foot and ankle pain treated without surgery?
The foundation is a progressive loading program (such as eccentric calf raises for the Achilles) plus footwear, orthotics, and gait strategies. For pain that persists for months, Dr. Gruner offers ultrasound-guided PRP, the Tenex procedure, or tendon scraping — directly addressing the degenerated tissue while preserving the tendon, so you can return to activity faster than with open surgery.
Ankle & Foot conditions we treat
Achilles TendinopathyPain in the back of the heel or calf from Achilles tendon overuse.Plantar Fasciopathy (Plantar Fasciitis)Stubborn heel pain, worst with the first steps in the morning.Ankle & Foot ArthritisCartilage wear in the ankle and foot joints causing pain, stiffness, and swelling with walking.Peroneal TendinopathyPain and swelling along the outer ankle tendons, often after ankle sprains or with instability.Morton's NeuromaA thickened nerve between the toes causing forefoot burning and the feeling of a pebble in the shoe.
Treatments and procedures for the ankle & foot
PRPConcentrated platelets from your own blood, injected under ultrasound guidance to support healing in joints and tendons.Microfragmented AdiposeA minimally processed sample of your own fat — microfragmented adipose tissue (MFat) — injected to cushion and support arthritic or injured joints.MSK UltrasoundIn-office, real-time imaging of tendons, ligaments, nerves, and joints — no radiation — to pinpoint the source of pain.TenexUltrasound-guided removal of damaged tendon tissue through a tiny opening — no open surgery.Tendon ScrapingA 2mm procedure that removes pain-causing tissue from the tendon's surface while preserving the tendon.
Rehabilitation protocols
What to expect week by week after your procedure. Your plan is individualized; follow these alongside your physical therapist.
Foot (Plantar Fascia) — Ultrasound-Guided Tenotomy / PRP Protocol
Download full protocol (PDF)
Week 1
Protect, reduce pain and swelling
- Non-weight-bearing with crutches in a CAM boot
- Avoid stretching into dorsiflexion; rest and elevate
- Gentle active ankle ROM; day 4 begin isometrics (toe crunches)
Week 2
Restore ROM, progress weight bearing
- Partial weight-bearing in CAM boot (pain-limited)
- Core and non-weight-bearing lower-limb strengthening
- Optional BFR
Weeks 2–4
Restore mechanics and tolerance
- Week 3: weight-bear as tolerated in boot, crutches as needed
- Gentle ankle dorsiflexion stretching; isometric ankle strengthening
- Non-impact aerobic exercise
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Achilles Tendon — Ultrasound-Guided Tenotomy / PRP Protocol
Download full protocol (PDF)
Week 0–1
Protect, reduce pain and swelling
- Non-weight-bearing with crutches in a CAM boot
- Gentle active ankle ROM; gait training with crutches
- Optional BFR 0–2 weeks
Weeks 1–2
Restore ROM, minimize atrophy
- Partial weight-bearing in CAM boot (pain-limited)
- Core and non-weight-bearing lower-limb strengthening
- Upper-body aerobic/strength work
Weeks 2–4
Progress weight bearing
- Continue weight-bearing progression
- Restore normal joint mechanics
- Increase tendon tolerance to daily activities
Do not use NSAIDs (ibuprofen, Aleve, aspirin) for 4 weeks, and avoid ice for the first week — both blunt the healing response. Acetaminophen (Tylenol) is fine for discomfort. Care is tailored to you; use these guidelines with your physical therapist.
Frequently asked questions
- Why won't my plantar fasciitis or Achilles pain go away?
- Both are tendon/fascia degeneration rather than simple inflammation, so rest alone rarely resolves them. They need targeted loading and, for stubborn cases, ultrasound-guided PRP, Tenex, or tendon scraping.
- Can I keep running with Achilles tendinopathy?
- Often yes, with modification. Dr. Gruner helps you adjust load and mechanics while a progressive strengthening program rebuilds the tendon — complete rest is usually neither necessary nor ideal.
Request an appointment
Schedule a comprehensive evaluation to discuss your non-surgical treatment options.
Bethesda, MD 20817(301) 530-1010