Heel pain can be caused by many different conditions and is referred to as plantar heel pain syndrome as there is the possibility of many differential diagnoses.
The most common cause of heel pain underneath the foot is plantar fascia pain. This is linked to many different injuries such as calcaneal nerve or tibial nerve entrapment, heel spur syndrome and calcaneal fractures. Pain at the back of the heel can be due to Achilles tendinopathy, fat pad contusion or acute bursitis pain.
Plantar fascia pain syptoms:
- Pain on the bottom of your feet after standing or working all day
- Pain on the bottom of your feet after sitting for periods of time at a desk or driving a car
- Morning pain when you take your first few steps out of bed which generally improves as you go
- Pain during walking or running
Calcaneal or tibial nerve entrapment
The calcaneal nerve is a branch off the tibial nerve. Both nerves attach to the bottom aspect of the foot but the symptoms and area of pain helps to differentiate which one a patient has a problem with. This injury is also associated with problems further up the leg at the sciatic nerve or the lower back.
- Sensation of burning, tingling or numbness
- Shooting pain up or down the foot or leg
- Muscle weakness depending on which nerve is affected
- Positive Tineals test
Heel spurs syndrome symptoms
- Aching or sharp pain when walking around which is relieved by sitting down
- Can be part of plantar fascia pain but is not always associated
- Easy to see on x-ray but may not be the origin of the pain as not everyone with a heel spur develops pain.
- Heel fractures (calcaneal fractures): This is not very common and is generally associated with trauma e.g. landing heavily on heals on a hard surface. The subjective and objective assessments of these injuries need to be precise and a good Podiatrist can pick-up the clinical signs.
Heel fractures (Calcaneal fractures)
This is not very common and is generally associated with trauma e.g. landing heavily on heals on a hard surface. The subjective and objective assessments of these injuries need to be precise and a good podiatrist can pick-up the clinical signs.
- Sharp local pain
- Usually caused by a traumatic event
- Could present with swelling but not always
What can The Podiatrist do for you?
- We can diagnose the injury or send you for further diagnostic testing
- We can off-load it with strapping, orthotics or heel raises
- We can refer you for strengthening regimes or prescribe them ourselves
- If we can’t fix it or the injury needs specialised diagnostic testing we can refer you to the people you need to see