Contents

Search

heel pain

Etiology: 1) inferior a) plantar fasciitis or fascial rupture b) arthritis - spondyloarthropathy - rheumatoid arthritis c) calcaneal fracture d) nerve entrapment e) lumbar or S1 radiculopathy 2) posterior a) Achilles tendonitis or rupture b) Halund deformity 'pump bump' c) bursitis d) calcaneal apophysitis (Sever's disease) in children 3) medial a) posterior tibial tendonitis b) tarsal tunnel syndrome c) nerve entrapment Clinical manifestations: 1) tenderness over bone, tendon, plantar fascia, &/or soft tissue may be present 2) pain with medial & lateral compression of the calcaneus (stress fracture) 3) positive Tinel's sign (tarsal tunnel) 4) palpable gap in Achilles tendon 5) Thompson test: no plantar flexion noted on squeezing calf with rupture of Achilles tendon 6) cavus or pronated foot associated with plantar fasciitis - pain with first step on rising in the morning & after periods of rest Laboratory: 1) erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) if indicated 2) rheumatoid factor (RF) if indicated Special laboratory: 1) electromyography (EMG) 2) nerve conduction velocity Radiology: plain radiograph of calcaneus Management: R: rest from pain-eliciting activities I: ice for 20 minutes several times/day while area is swollen C: compression with padding & a wrap E: elevation above level of heart to reduce edema D: non-steroidal anti-inflammatory Drugs (NSAIDs) for pain & inflammation if not contraindicated 1) supportive footwear with heal support, lace-up shoes 2) see plantar fasciitis 3) posterior tibialis tendonitis: a) medial arch support or wedge b) physical therapy 4) Haglund deformity, Achilles tendonitis or bursitis a) 1/4 inch heel wedge b) calf stretching c) physical therapy 5) Achilles tendon rupture: surgical consultation 6) shock wave therapy vs surgery for plantar osteophytes (spurs) [2,3] 7) foot orthotics offer no advantage over other conservative treatments [5]

Related

heel plantar fasciitis

General

foot pain

References

  1. Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 751-52
  2. Journal Watch 22(9):73, 2002 Rompe JD et al, J Bone Joint Surg Am 84:335, 2002 PMID: 11886900
  3. Journal Watch 24(2):16-17, 2004 Gerdesmeyer L, JAMA 290:2573, 2003 PMID: 14625334
  4. Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
  5. Rasenberg N, Riel H, Rathleff MS et al Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. British J Sports Med. 2018 PMID: 29555795 http://bjsm.bmj.com/content/early/2018/02/23/bjsports-2017-097892
  6. Diagnosis and Treatment of Heel Pain American College of Foot and Ankle Surgeons http://www.acfas.org/HealthcareCommunity/Content.aspx?id=365