Heel Pain and Plantar Fasciitis. Part 2 – Help me Diagnose the Pain.

Diagnosing heel pain is not that simple even for the medical practitioners as a lot tiny soft tissue structures are located in the area. So “googling” and self-diagnosing can be very risky and lead you to many ineffective internet purchases. Although I do not advocate self-diagnosis, I do want to support and assist many of those who feel stuck and are struggling to get results. This blog discusses some basic tips on how to help identify the cause of your pain which may give you a better direction of management.

Is the pain at back of the heel bone or under the heel bone?

1.Back of the heel bone.  

If you are under 15 years of age and you feel pain pressing on the back of the heel, then it is very likely you may have Sever’s disease. This is inflammation of the growth plate on the heel bone at the point of Achilles insertion.

If you are an adult, then we need to further isolate the location of the pain. If the pain is directly at the back of the heel bone then it is likely to be Achilles tendinopathy or Achilles tendonitis. If the pain is on squeezing either side of the Achilles at the level of the heel bone, then you may have retrocalcaneal bursitis. If there is a bump on the back of the heel bone and the pain is focalized to that area, then you may have Haglund’s deformity.

2.Under the heel

The description and type of pain in the heel helps to further diagnose the pain.

Is it a sharp/non-radiating type of pain or is it a burning/radiating type of pain?

a. If it feels sharp then we need to further identify the timing of the pain. If it occurs upon initial standing or walking after a prolonged period of resting, especially when you first step out of bed in the morning then it is very likely to be plantar fasciitis. If the pain occurs after being on your feet for a prolonged period of time, such as the end of the day then it is likely to be heel pad syndrome. If the pain occurs mostly when resting and not standing on your feet, then it could indicate a stress fracture.

b.If the pain is radiating and/or burning we need to indicate the location of the pain to further identify the diagnosis. If the pain is on the inside and at the base of the heel, it maybe Baxter’s nerve entrapment. If the pain is moreso towards the inside of the ankle and/or further back at the base of the heel then it maybe tarsal tunnel syndrome.

 

Conclusion:

Heel pain is very common but often misdiagnosed and treatment may not be targeting the diagnosis specifically. It is imperative that correct diagnosis is made to ensure proper management follows.

In part 3 of heel pain, discussion of how relevant and when is imaging require.  Xray’s, ultrasound, CT scans and MRI will be explained and which image is recommended to further investigate heel pain.

 

Dr Vanessa Hadchiti (Podiatrist)

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