Podiatrists see many patients who complain of heel pain. A detailed history and physical exam form the foundation for making an accurate diagnosis of heel pain. However, imaging plays a vital role in preventing misdiagnosis or failure from making an accurate diagnosis. Likelihood ratios are used to determine the value of imaging for common causes of heel pain. It would help if you saw a New York heel pain specialist for proper diagnosis and treatment.
Heel pain can occur anywhere along the course of the plantar fascia but is most common at its origin, typically located 2-5 cm proximal to the medial tuberosity on the calcaneal bone. The heel consists of many different tissues, including muscles, ligaments, tendons, fat, bursae, and bone. In this article, we discuss some of the most common causes of heel pain.
- Stress Fractures
Stress fractures are increasingly diagnosed with greater accuracy due to the widespread use of high-resolution imaging modalities. Stress fractures of the calcaneus can be divided into weight-bearing (lateral or medial), and non-weight bearing lateral stress fractures tend to occur in athletes participating in repetitive activities like running. In contrast, non-weight bearing medial stress fractures may occur in the setting of excessive pronation due to subtalar joint pathology.
- Plantar Fasciitis
The plantar fascia is a thick band of connective tissue that originates from the medial tubercle and attaches to the calcaneus. It acts as a shock absorber during weight-bearing activities, particularly in patients with hyperpronation or flat feet. Patients with chronic plantar fasciitis typically report morning heel pain which generally resolves with walking over the day. If there is no improvement, patients may complain of pain with weight-bearing activities or at night. Plantar fasciitis is likely when the physical exam reveals focal tenderness.
- Achilles Tendonitis
Microtears often cause Achilles tendonitis due to repetitive activities. Patients with Achilles tendonitis typically report increased pain with weight-bearing activities or at night. However, some patients may complain of sharp heel pain during the activity, which resolves once they stop running. A physical exam reveals focal tenderness when palpating the Achilles tendon proximal to its insertion into the calcaneus.
- Heel Spurs
A heel spur is a calcification that forms at the insertion point of the plantar fascia into the calcaneus. It can cause symptoms similar to plantar fasciitis, although patients generally do not experience morning pain unless it compresses or irritates a nearby nerve root. Patients describe the onset of symptoms after an increase in activity level, such as running or jumping. A physical exam of the plantar fascia may reveal thickening and point tenderness along the course of the plantar fascia that is worse than expected, given a history of prior heel pain.
- Overuse
These injuries can be challenging to diagnose because they are rare compared with other common medical conditions. Such diagnoses may not be made for weeks or months, leading to the potential for chronic pain and disability. To prevent this, physicians need a tool to determine if imaging helps accurately diagnose overuse injury.
In summary, heel pain is a common condition that results from many different causes. Some of the most common reasons many people experience heel pain include overuse injuries, plantar fasciitis, Achilles tendonitis, heel spurs, and stress fractures.
Be First to Comment