Examining the Patient
Pain or tenderness over the inside of the heel suggest plantar fasciitis. If the entire heel is tender this would then suggest a stress fracture. If the patient is a child then it may be severs disease. Sever’s disease or Calcaneal apophysitis is a condition that affects children between the ages of 10 and 13 years. It is characterized by pain in one or both heels with walking. During this phase of life, growth of the bone is taking place at a faster rate than the tendons. Hence there is a relative shortening of the heel-cord compared to the leg bones.
If the patient is elderly and there is pain under the fat pad this would suggest fat pad atrophy. When examining the heel the patient complains of a shooting pain that radiates to the large toe, this would point to nerve entrapment. If there is a nodule (lump) under the arch this indicates a possible rupture of the plantar fascia and the need for surgery.
If there is localized pain, swelling, tenderness and warmth around the heel this is a sign of a soft tissue infection and requires the patient to visit the hospital ASAP.
X-Rays: X-Rays may show a bony growth called a heel spur. X-Rays can also diagnose a heel stress fracture.
Ultrasound: May show a plantar fascia rupture.
MRI (Magnetic resonance imaging): Can show up a soft tissue injury, stress fracture and plantar fasciitis