Unbound MEDLINE

Diagnosis of heel pain.

Abstract

Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.

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  • Publisher Full Text
  • Authors

    Tu P, Bytomski JR

    Institution

    Duke University, Durham, NC 27710, USA. priscilla.tu@duke.edu

    Source

    American family physician 84:8 2011 Oct 15 pg 909-16

    MeSH

    Achilles Tendon
    Calcaneus
    Diagnosis, Differential
    Fasciitis, Plantar
    Foot Diseases
    Fractures, Stress
    Heel
    Heel Spur
    Humans
    Pain
    Tarsal Tunnel Syndrome
    Tendinopathy

    Pub Type(s)

    Journal Article
    Review

    Language

    eng

    PubMed ID

    22010770