Heel pain is a common occurrence, yet is frequently misdiagnosed.  There are many possible reasons for heel pain. 

Possible Causes for Heel Pain:

  • Plantar Fasciitis  - A soft tissue problem
  • Partial Longitudinal Plantar Fascial Tear - where the plantar fascia inserts onto the calcaneus (heel bone). 
  • Calcaneal Stress Fracture
  • Calcaneal bone cyst
  • Nerve Problems including tarsal tunnel syndrome, medial calcaneal neuritis and/or compression.
  • Bone Spur  - avulsion fracture of the plantar calcaneal enthesopathy

The term “bone spur” is sometimes used to describe heel pain.  This can be misleading because many people have “bone spurs” to the calcaneus, both on the bottom where the plantar fascia inserts and to the back where the Achilles tendon inserts, but have no pain.  “Bone spurs” themselves do not cause pain; bone does not have nerve endings.  What is causing the pain is the soft tissue that is attached to the area – plantar fasciitis.

Diagnostic Testing:
Diagnostic testing is performed to determine the cause of the heel pain, which will then determine the treatment plan.

  • Foot X-Rays - initially taken to assess the basic underlying bone
  • Diagnostic Sonography – to  visualize the plantar fascia to measure its thickness, assess for inflammation, and to check for any tears. Also to visualize any focal compression of the tibial nerve in the tarsal tunnel area.
  • MRI - to better visualize for suspected partial tears or to better assess for a calcaneal stress fracture
  • Quantitative Sensory Testing with Pressure-Specified Sensory Device (PSSD) - to assess for any sensory loss from focal nerve compressions involving the tibial nerve, medial plantar nerve, lateral plantar nerve or the medial calcaneal nerve.

Depending on the cause of your heel pain, there are many treatment options, both conservative and surgical, to treat your heel pain.

Conservative treatment options – May include but are not limited the following depending on the cause of your heel pain:

  • Series of corticosteroid injections
  • Icing of the heel
  • Stretching exercises of the plantar fascia
  • Functional running shoes and over-the-counter arch supports/inserts
  • Custom-made functional orthotic devices
  • Removable Walking Boot
  • Fiberglass casting with crutches.

 

Surgical options – May include but are not limited to the following depending on the cause:

  • Instep Plantar Fasciotomy:  partial lengthening of the plantar fascia to remove the constant pulling at its insertion site
  • Tarsal Tunnel Release:  medial ankle nerve decompressions of the tibial, medial plantar, lateral plantar, medial calcaneal nerves to resolve the chronic nerve compression(s).