Advice on Foot Care

Not all heel pain is plantar fasciitis. Plantar fasciitis, tearing and inflammation of a long ligament on the bottom of the foot, is the most common cause of heel pain. But, there are many other less common conditions which can cause heel pain and may sometimes be confused with plantar fasciitis.

Rupture (Ligament tear on bottom of the foot): A complete tear of the plantar fascia is rare but can happen. Acute pain develops after an incident or an injury, such as after jumping and landing on the foot, or even taking off quickly for a sprint. Bruising and swelling may accompany the pain at the bottomo of the heel. Treatment is generally 4-8 weeks of immobilization. This may involve a below the knee cast or a cast boot.

Calcaneal Spur Fracture (Broken heel spur): A spur can develop on the bottom of the heel in response to traction from the plantar fascia, but is rarely a cause of pain. In rare cases, a larger spur can be broken. This is generally caused from an injury such as jumping and landing on the heel. Pain develops suddenly and is commonly followed with bruising and swelling on the bottom of the heel. The pain is worsened with walking and better with rest. Treatment should be a 4-8 week period of immobilization.

Calcaneal Stress Fracture (Partial break of the heel bone): The heel bone, calcaneus, is under a tremendous amount of impact when walking. In some cases the heel bone can crack, which does not result from an injury or traumatic event. The stress fracture is more likely due to repetitive stress on the heel. The pain is at the heel, on the bottom and both sides, generally described as dull and achy, but sharp with walking or standing. The heel may become swollen, but is generally not bruised. Treatment involves a weight bearing removable below the knee cast for 4-6 weeks. Exercises such as swimming may be beneficial to maintain fitness during the recovery period.

Low Back Pain/Sciatica: Pain in the heels can be a result of a low back problem or sciatica. It is unlikely that the pain would be isolated to the heels, but possible. The pain may be burning, tingling or cause numbing pain. There is no pain when taking those first few steps in the morning and pain may worsen with sitting, driving or lying down. Evaluation by a general physician, orthopedist or neurologist is recommended.

Nerve Entrapment: Pinching of a nerve in the heel can develop after the initial phases of plantar fasciitis. Once the plantar fascia has inflamed and thickened, in response to the repetitive injury and tearing, this can entrap or irritate a nerve which courses under the heel bone. Tingling, burning, numbness or electrical pain may or may not be present, which may make the diagnosis difficult. Luckily, the initial treatment for plantar fasciitis and nerve entrapment are very similar. Decreasing stress on the heel and reducing inflammation are the most effective conservative therapies. Aggressive stretching of the plantar fascia and calf can potentially worsen the nerve entrapment. Steroid injections may be beneficial. When conservative treatments fail, surgical release of the nerve may be warranted.

Tarsal Tunnel Syndrome: Entrapment of the posterior tibial nerve within the tarsal tunnel (at the inside of the ankle) is the cause of tarsal tunnel syndrome. Similar to carpal tunnel syndrome, but much much less common, the main nerve supplying the bottom of the foot becomes compressed at a tunnel-like space in the ankle. Pain is generally radiates to the bottom of the foot, but sometimes up the leg. It can be dull and burning at the ankle, heel or foot or may be sharp with walking. The pain worsens with activity but may only sometimes relieved by rest. There are many possible causes of tarsal tunnel, a few include tumors, varicose veins, bone spurs, inflamed tendons, but is more commonly caused by strain on the tissue due to mechanical factors affecting the foot. The treatment depends on the cause of the nerve compression.

Bone Tumor: Bone tumors in the heel bone are fortunately rare and generally benign. The pain generally starts as a dull, achy pain at the heel, but quickly worsens. Many times the heel swells, even though there is no history of injury or trauma. An X-Ray will show a bone tumor or cyst. Depending on the level of pain and swelling and what the X-rays show, a CT scan or MRI may be recommended. Treatment depends on the type of cyst or tumor in the heel.

Arthritis: Systemic arthritic diseases can be a cause heel pain. Although conditions like rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis or Reiter’s Disease can all cause heel pain, they are not common causes. Typical treatments for conditions like plantar fasciitis may be helpful, but the underlying disease must be addressed.

More details, information and pictures on common causes of heel pain. More details and information on plantar fasciitis.

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