Heel Pain
Heel pain in adults can be caused by various soft tissue, osseous, and systemic disorders. A thorough work up of the lower extremity should be conducted to locate the pain, define its attributes, and narrow the differential diagnosis . By far the most common heel pain seen is caused by inflammation of the band ( Plantar fascia) attached to the heel bone. This is called plantar fasciitis and typically caused by repetitive use or excessive load on the fascia. The typical presentation is a gradual onset of plantar heel pain that is worse on taking the first steps in the morning or when standing up after prolonged sitting. Tenderness over the medial aspect of the calcaneal tuberosity usually is demonstrated, and the pain increases when the plantar fascia is stretched by passive dorsiflexion of the toes.
Acute onset of severe plantar heel pain after trauma or vigorous athletics may indicate rupture of the plantar fascia. Findings suggestive of rupture include a palpable defect at the calcaneal tuberosity accompanied by localized swelling and ecchymosis.
If conservative treatment of plantar fasciitis fails to alleviate symptoms, radiographs are advisable to check for other causes of heel pain such as stress fractures, arthritis, or skeletal abnormalities. Radiographs may reveal a calcification of the proximal plantar fascia, which is known as a heel spur. However, these spurs often are present in asymptomatic persons, are nonspecific, and should not be construed as an explanation for heel pain.
Differential diagnosis for heel pain include:
- Tendinitis
- Achilles tendinitis
- Retroachilles bursitis
- Retrocalcaneal bursitis
- Plantar fascia rupture
- Heel pad atrophy
- Tarsal tunnel syndrome
- Neuroma
- Bone cyst
- Osteomyelitis
- Fracture
- Tumor
Treatment
- Wear proper footwear.
- Orthotics to control the abnormal motion which is the causative agent for the inflammation.
- Correct leg length discrepancy via an adjustable heel lift.
- Oral and topical anti-inflammatory medication.
- Ice massage to reduce inflammation and relieve tension.
- Stretch calf muscle to reduce tightness. However this is not advised during the acute phase since it can exacerbate the symptoms
- Use of a night splint to give a constant passive stretch to the plantar fascia.
Latest Developments
There has been great advances in non-surgical treatments for heel pain. We have been very reluctant to use surgery until all conservative options are exhausted. Recently, our office has started a procedure called "PRP" injection into the heel region. PRP (platelet rich plasma) is the portion of the blood that is harvested from your own blood and is re-injected back into the heel area to re-start the healing. PRP injection has been very succesful in treating chronic cases of plantar fasciitis and achilles tendinosis.
Cryotherapy ( Freezing) is also another modality used in the fight against heel pain but the jury is still out on its effectiveness.