Diagnosing Heel Pain

Differential Diagnosis

Other conditions that can cause heel pain include:

  • Stress fracture of the heel

This is a common condition for soldiers or runners who do a lot of marching or road running. Symptoms include Insidious, gradual onset heel pain which is often made worse by weight bearing activities. Often an X-ray of the injured bone will not show any sign of fracture until the fracture has actually started to heal (2-3 weeks later). It is recommended in the case of a stress fracture that you should rest completely for 6-8 weeks. Crutches can be helpful.

  • Fat pad atrophy

The skin of the outer surface of the heel is thick, providing protection for the foot in standing and walking. Under to the skin lies the fat pad, which consists of tightly woven fibrous septa. Atrophy of the fat pad may contribute to heel pain in older patients.

  • Entrapment of medial and lateral calcaneal nerve

When there is an excessive over pronation or pressure from shoes, in effect the medial nerve can become trapped. Pain will radiate from the inside of the heel out towards the centre of the heel.

  • Tarsal tunnel syndrome

Nerves called the medial and lateral plantar nerves run along the inside of the ankle and go to either side of the heel. If you over pronate (your foot rolls in excessively ) then the pressure is put on these nerves which can become inflamed, causing tarsal tunnel syndrome. This results in sharp pain radiating into the arch of the foot, heel and sometimes the toes.

  • Infection

Soft tissue infection with or without abscess is a possible cause of heel pain. Cardinal signs of infection with bone involvement make up the typical presentation. Incision and drainage with appropriate oral or intravenous antibiotics are the treatments of choice.

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