Materiały źródłowe

• #1 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #2 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyter.com/document/doi/10.7556/jaoa.2014.177/html?lang=en

  Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. Individuals with plantar fasciitis experience pain that is most intense during their first few steps of the day or after prolonged standing. The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. Overall, plantar fasciitis carries a good prognosis when patients use a combination of several conservative treatment modalities. Occasionally, referral to a specialist may be necessary. […] The initial evaluation of plantar fasciitis often occurs in the primary care setting. Although the diagnosis is often straightforward, an extensive list of alternative diagnoses may need to be ruled out. Effective treatment is predicated on the modification of risk factors and the implementation of an evidence-based treatment approach. Ultimately, a good prognosis is expected.

• #3 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #4 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  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.

• #5 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #6 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #7 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #8 Tools to speed your heel pain diagnosis | MDedge

  https://mdedge.com/familymedicine/article/63367/pain/tools-speed-your-heel-pain-diagnosis

  Quickly zero in on a diagnosis by using our handy “photo guide” and reference table. […] Knowing the precise location of maximum pain or tenderness and pairing that with key findings from the exam and history can help you reach an accurate diagnosis and formulate proper treatment. […] Each of the 3 general areas of heel pain—posterior, plantar, and medial—introduces a unique differential. Bilateral symptoms or multiple joint involvement, of course, raises the possibility of associated systemic disease. […] The common causes of posterior heel pain are Achilles tendinopathy, retrocalcaneal bursitis, calcaneal apophysitis, posterior impingement, and Achilles tendon strain or rupture. Rarer causes are sciatica, peroneal tendonitis, Haglund’s deformity, pump bump, and systemic disorders. The patient’s history and precise location of maximal tenderness differentiates these problems.

• #9 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #10 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #11 Expert Opinion: A Review of the Evaluation and Treatment of Heel Pain, Part 1

  https://practicalneurology.com/articles/2015-june/expert-opinion-a-review-of-the-evaluation-and-treatment-of-heel-pain-part-1

  A thorough history in the patient with heel pain is essential for determining a diagnosis and treatment plan. Most importantly, detailed questioning of the patient should be performed to precisely localize the pain to either a plantar, midfoot, or posterior location. Next, the quality of the pain should be clearly detailed. For instance, patients with plantar pain should be questioned about a significant burning and tingling component, which may suggest nerve entrapment or a neuroma. […] Additionally, the timing of pain episodes should be obtained. Commonly, patients with plantar fasciitis will describe their worst pain with their first weight bearing steps after sleep or other restful periods. However, if upon history patients describe pain that gets worse with prolonged weight bearing, then heel pad syndrome or a plantar wart should be considered as possible etiologies. Patients who report continuous pain at rest should be evaluated for a bony derangement such as calcaneal stress fracture.

• #12 Expert Opinion: A Review of the Evaluation and Treatment of Heel Pain, Part 1

  https://practicalneurology.com/articles/2015-june/expert-opinion-a-review-of-the-evaluation-and-treatment-of-heel-pain-part-1

  A thorough history in the patient with heel pain is essential for determining a diagnosis and treatment plan. Most importantly, detailed questioning of the patient should be performed to precisely localize the pain to either a plantar, midfoot, or posterior location. Next, the quality of the pain should be clearly detailed. For instance, patients with plantar pain should be questioned about a significant burning and tingling component, which may suggest nerve entrapment or a neuroma. […] Additionally, the timing of pain episodes should be obtained. Commonly, patients with plantar fasciitis will describe their worst pain with their first weight bearing steps after sleep or other restful periods. However, if upon history patients describe pain that gets worse with prolonged weight bearing, then heel pad syndrome or a plantar wart should be considered as possible etiologies. Patients who report continuous pain at rest should be evaluated for a bony derangement such as calcaneal stress fracture.

• #13 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #14 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  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.

• #15 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #16 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  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.

• #17 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents). Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #18 Heel Pain: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29365222/

  The differential diagnosis of heel pain is extensive, but a mechanical etiology is the most common. The specific anatomic location of the pain can help guide diagnosis. The most common diagnosis is plantar fasciitis, which leads to medial plantar heel pain, especially with the first weight-bearing steps after rest. Other causes of plantar heel pain include calcaneal stress fractures (progressively worsening pain after an increase in activity or change to a harder walking surface), nerve entrapment or neuroma (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), and plantar warts. […] Achilles tendinopathy is a common cause of posterior heel pain; other tendinopathies result in pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to Haglund deformity (a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation) or Sever disease (calcaneal apophysitis common in children and adolescents).

• #19 Heel Pain: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29365222/

  Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #20 Heel Pain: Diagnosis and Management – PubMed

  https://pubmed.ncbi.nlm.nih.gov/29365222/

  Medial midfoot heel pain, particularly with prolonged weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve. Sinus tarsi syndrome manifests as lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces.

• #21 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #22 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #23 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #24 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Calcaneal stress fractures are caused by repetitive overload to the heel and most commonly occur immediately inferior and posterior to the posterior facet of the subtalar joint. Pain usually begins after an increase in weight-bearing activities or after changing to a harder walking surface. The pain initially occurs only with activity, but it can later occur at rest. Swelling or ecchymosis may be noted on examination, with point tenderness at the fracture site. A positive calcaneal squeeze test (i.e., pain on squeezing the sides of the calcaneus) suggests the diagnosis. Radiography often does not reveal a fracture, so bone scans, computed tomography, or MRI may be required. Activity modification, with little to no weight bearing for up to six weeks if pain is severe, is usually successful. Heel pads or walking boots can also be used. Calcaneal stress fractures tend to heal well in otherwise healthy patients.

• #25 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Calcaneal stress fractures are caused by repetitive overload to the heel and most commonly occur immediately inferior and posterior to the posterior facet of the subtalar joint. Pain usually begins after an increase in weight-bearing activities or after changing to a harder walking surface. The pain initially occurs only with activity, but it can later occur at rest. Swelling or ecchymosis may be noted on examination, with point tenderness at the fracture site. A positive calcaneal squeeze test (i.e., pain on squeezing the sides of the calcaneus) suggests the diagnosis. Radiography often does not reveal a fracture, so bone scans, computed tomography, or MRI may be required. Activity modification, with little to no weight bearing for up to six weeks if pain is severe, is usually successful. Heel pads or walking boots can also be used. Calcaneal stress fractures tend to heal well in otherwise healthy patients.

• #26 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain accompanied by burning, tingling, or numbness may suggest a neuropathic etiology, either with nerve entrapment or the development of a neuroma. Nerve entrapment can be caused by overuse, trauma, or injury from a previous surgery. Neuropathic plantar heel pain typically involves branches of the posterior tibial nerve, the lateral plantar nerve, or the nerve to the abductor digiti minimi. Lumbar radiculopathy at the L4-S2 levels should also be considered regardless of the presence of associated low back pain. Neuropathic heel pain is usually unilateral, and underlying systemic disease should be ruled out in patients with bilateral pain. MRI and ultrasonography may be helpful in visualizing the nerve entrapment. Treatment initially involves rest, ice, use of anti-inflammatory or analgesic medications, relief of pressure at the pain site, and stretching. Surgical decompression should be considered if conservative treatment is ineffective.

• #27 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain accompanied by burning, tingling, or numbness may suggest a neuropathic etiology, either with nerve entrapment or the development of a neuroma. Nerve entrapment can be caused by overuse, trauma, or injury from a previous surgery. Neuropathic plantar heel pain typically involves branches of the posterior tibial nerve, the lateral plantar nerve, or the nerve to the abductor digiti minimi. Lumbar radiculopathy at the L4-S2 levels should also be considered regardless of the presence of associated low back pain. Neuropathic heel pain is usually unilateral, and underlying systemic disease should be ruled out in patients with bilateral pain. MRI and ultrasonography may be helpful in visualizing the nerve entrapment. Treatment initially involves rest, ice, use of anti-inflammatory or analgesic medications, relief of pressure at the pain site, and stretching. Surgical decompression should be considered if conservative treatment is ineffective.

• #28 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Pain from heel pad syndrome is described as a deep, bruise-like pain, usually in the middle of the heel, and can be reproduced with firm palpation. Pain may be elicited by walking barefoot, on harder surfaces, or for prolonged periods. This syndrome is typically caused by inflammation but can also be due to damage to or atrophy of the heel pad. Decreased heel pad elasticity from aging, prior corticosteroid injections, or increased body weight may also contribute. Treatment is aimed at decreasing pain with rest, ice, taping, and the use of anti-inflammatory or analgesic medications, heel cups, and proper footwear. […] The Achilles tendon is formed from the merging of the soleus and gastrocnemius muscles, and it inserts into the calcaneus. Excessive mechanical loading of the muscle, such as with increased running, can cause tendinopathy that leads to posterior heel pain. The pain associated with Achilles tendinopathy is achy, occasionally sharp, and worsens with increased activity or pressure to the area. The diagnosis can be classified as insertional or within the midsubstance of the tendon. Palpation should reveal tenderness along the tendon and sometimes a prominence from tendon thickening. Passive dorsiflexion of the ankle increases pain. Radiography may demonstrate spurring at the tendon insertion or intratendinous calcifications. Ultrasonography may demonstrate thickening of the tendon. Effective treatments include activity modification, eccentric exercises, reduction of pressure to the area, deep friction massage, tendon mobilization, and use of analgesic medications and heel lifts or other orthotic devices. Some studies have shown benefit with extracorporeal shock wave therapy and nitroglycerin patches. Kinesiology taping and corticosteroid or platelet-rich plasma injections have been found ineffective for Achilles tendinopathy. Injections, particularly with corticosteroids, should be avoided because of the risk of tendon rupture. Severe cases may require surgery.

• #29 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  Radiography is usually not necessary, although weight-bearing radiography can help rule out other causes of heel pain. […] Approximately 50 percent of patients with plantar fasciitis have heel spurs, but they are most often an incidental finding and do not correlate well with the patient’s symptoms. […] Initial treatment of heel pain caused by nerve entrapment includes rest, ice, anti-inflammatory or analgesic medications, relief of pressure at the site of pain, and stretching exercises. If conservative measures are ineffective after six to 12 months, surgical decompression should be considered. […] Pain from heel pad syndrome is often erroneously attributed to plantar fasciitis. Patients with heel pad syndrome present with deep, bruise-like pain, usually in the middle of the heel, that can be reproduced with firm palpation.

• #30 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Pain from heel pad syndrome is described as a deep, bruise-like pain, usually in the middle of the heel, and can be reproduced with firm palpation. Pain may be elicited by walking barefoot, on harder surfaces, or for prolonged periods. This syndrome is typically caused by inflammation but can also be due to damage to or atrophy of the heel pad. Decreased heel pad elasticity from aging, prior corticosteroid injections, or increased body weight may also contribute. Treatment is aimed at decreasing pain with rest, ice, taping, and the use of anti-inflammatory or analgesic medications, heel cups, and proper footwear. […] The Achilles tendon is formed from the merging of the soleus and gastrocnemius muscles, and it inserts into the calcaneus. Excessive mechanical loading of the muscle, such as with increased running, can cause tendinopathy that leads to posterior heel pain. The pain associated with Achilles tendinopathy is achy, occasionally sharp, and worsens with increased activity or pressure to the area. The diagnosis can be classified as insertional or within the midsubstance of the tendon. Palpation should reveal tenderness along the tendon and sometimes a prominence from tendon thickening. Passive dorsiflexion of the ankle increases pain. Radiography may demonstrate spurring at the tendon insertion or intratendinous calcifications. Ultrasonography may demonstrate thickening of the tendon. Effective treatments include activity modification, eccentric exercises, reduction of pressure to the area, deep friction massage, tendon mobilization, and use of analgesic medications and heel lifts or other orthotic devices. Some studies have shown benefit with extracorporeal shock wave therapy and nitroglycerin patches. Kinesiology taping and corticosteroid or platelet-rich plasma injections have been found ineffective for Achilles tendinopathy. Injections, particularly with corticosteroids, should be avoided because of the risk of tendon rupture. Severe cases may require surgery.

• #31 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The most common etiology of heel pain in children and adolescents is Sever disease (calcaneal apophysitis). Patients usually present between eight and 12 years of age with activity-associated heel pain, particularly with running or jumping, that is often worse at the beginning of a new sports season or during a growth spurt. Pain may be elicited by palpation around the Achilles insertion site, with mediolateral calcaneal compression, and with passive dorsiflexion. Radiographic findings are typically normal but may show fragmented or sclerotic calcaneal apophysis. Treatment is conservative and includes limiting of pain-inducing activities, use of anti-inflammatory or analgesic medications, ice, stretching and strengthening the gastrocnemius-soleus complex, and shoe modifications with orthotics, heel cups, or lifts.

• #32 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  The most beneficial treatment of Achilles tendinopathy is eccentric exercises, which involve lengthening a muscle in response to external resistance. Initial treatment should also include reduction of pressure to the area, heel lifts or other orthotic devices, and anti-inflammatory or analgesic medications. […] Sever disease (calcaneal apophysitis) is the most common etiology of heel pain in children and adolescents, usually occurring between five and 11 years of age. […] The tarsal tunnel is a fibroosseous space formed by the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Compression of the posterior tibial nerve most commonly occurs as it courses through this tunnel, causing neuropathic pain and numbness in the posteromedial ankle and heel, which may extend into the distal sole and toes.

• #33 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  The most common etiology of heel pain in children and adolescents is Sever disease (calcaneal apophysitis). Patients usually present between eight and 12 years of age with activity-associated heel pain, particularly with running or jumping, that is often worse at the beginning of a new sports season or during a growth spurt. Pain may be elicited by palpation around the Achilles insertion site, with mediolateral calcaneal compression, and with passive dorsiflexion. Radiographic findings are typically normal but may show fragmented or sclerotic calcaneal apophysis. Treatment is conservative and includes limiting of pain-inducing activities, use of anti-inflammatory or analgesic medications, ice, stretching and strengthening the gastrocnemius-soleus complex, and shoe modifications with orthotics, heel cups, or lifts.

• #34 Plantar fasciitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/drc-20354851

  Plantar fasciitis is diagnosed based on your medical history and physical exam. During the exam, your health care professional will check for areas of tenderness in your foot. The location of your pain can help determine its cause. […] Usually no tests are needed. Your health care professional might suggest an X-ray or MRI to make sure another problem, such as a stress fracture, is not causing your pain. […] Sometimes an X-ray shows a piece of bone sticking out from the heel bone. This is called a bone spur. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain. […] Your health care professional might refer you to someone who specializes in foot disorders or sports medicine. […] For plantar fasciitis, basic questions to ask your health care team include: What tests do I need? […] Your health care professional is likely to ask you questions, such as: What types of shoes do you usually wear?

• #35 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2014.177/html?lang=en&srsltid=AfmBOoqrfL6emNPiTk8gs9_9lXKHf56yZmx28gH00QyYOxnzMMsKEmEl

  Plantar fasciitis, a chronic degenerative process that causes medial plantar heel pain, is responsible for approximately 1 million physician visits each year. […] The authors provide an overview of the diagnosis and management of a common problem encountered in the primary care setting. […] Routine imaging is not initially recommended for the evaluation of plantar fasciitis but may be required to rule out other pathologic conditions. […] The initial evaluation of plantar fasciitis often occurs in the primary care setting. […] Although the diagnosis is often straightforward, an extensive list of alternative diagnoses may need to be ruled out. […] Effective treatment is predicated on the modification of risk factors and the implementation of an evidence-based treatment approach. […] Ultimately, a good prognosis is expected.

• #36 Expert Opinion: A Review of the Evaluation and Treatment of Heel Pain, Part 1

  https://practicalneurology.com/articles/2015-june/expert-opinion-a-review-of-the-evaluation-and-treatment-of-heel-pain-part-1

  A thorough physical exam of the entire ankle, heel and midfoot is critical to establish a proper diagnosis. Tenderness over the calcaneus and increased pain with passive dorsiflexion of toes may be suggestive of plantar fasciitis, one of the most common causes of heel pain. […] Heel pain may be due to arthritic, neurologic, traumatic or other systemic conditions but most commonly is mechanical in origin. The most common locations for mechanically-induced heel pain are the plantar and posterior heel. Plantar heel pain is the most prevalent complaint presenting to foot and ankle specialists, seen in up to 11-15 percent of adults and is due to plantar fasciitis, heel spur syndrome or plantar fasciosis. […] Standard radiographs are the first step in evaluation of heel pain. The source of pain from bone spurs, arthritis and tumors can be imaged with anterior-posterior and sagittal x-rays of the foot. Heel spurs, stress fractures and space occupying lesions would be assessed with this modality.

• #37 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #38 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  Radiography is usually not necessary, although weight-bearing radiography can help rule out other causes of heel pain. […] Approximately 50 percent of patients with plantar fasciitis have heel spurs, but they are most often an incidental finding and do not correlate well with the patient’s symptoms. […] Initial treatment of heel pain caused by nerve entrapment includes rest, ice, anti-inflammatory or analgesic medications, relief of pressure at the site of pain, and stretching exercises. If conservative measures are ineffective after six to 12 months, surgical decompression should be considered. […] Pain from heel pad syndrome is often erroneously attributed to plantar fasciitis. Patients with heel pad syndrome present with deep, bruise-like pain, usually in the middle of the heel, that can be reproduced with firm palpation.

• #39 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  More than 2 million persons present with plantar heel pain every year. Plantar fasciitis is the most common cause, with a lifetime prevalence of 10% in the general population. The primary symptom is usually throbbing medial plantar heel pain that is worse with the first steps after rest. The pain often decreases after further ambulation, but can return with continued weight bearing. Palpation of the medial calcaneal tuberosity and along the plantar fascia typically causes sharp, stabbing pain. Passive dorsiflexion of the foot and toes often elicits pain as well. Diagnostic imaging is not required, but weight-bearing radiography, magnetic resonance imaging (MRI), and ultrasonography can help rule out other causes of heel pain. Heel spurs are present in approximately 50% of patients with plantar fasciitis, but they do not correlate well with symptoms and can also be found in persons without plantar fasciitis.

• #40 Diagnosis of Heel Pain | AAFP

  https://www.aafp.org/pubs/afp/issues/2011/1015/p909.html

  Radiography is usually not necessary, although weight-bearing radiography can help rule out other causes of heel pain. […] Approximately 50 percent of patients with plantar fasciitis have heel spurs, but they are most often an incidental finding and do not correlate well with the patient’s symptoms. […] Initial treatment of heel pain caused by nerve entrapment includes rest, ice, anti-inflammatory or analgesic medications, relief of pressure at the site of pain, and stretching exercises. If conservative measures are ineffective after six to 12 months, surgical decompression should be considered. […] Pain from heel pad syndrome is often erroneously attributed to plantar fasciitis. Patients with heel pad syndrome present with deep, bruise-like pain, usually in the middle of the heel, that can be reproduced with firm palpation.

• #41 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Calcaneal stress fractures are caused by repetitive overload to the heel and most commonly occur immediately inferior and posterior to the posterior facet of the subtalar joint. Pain usually begins after an increase in weight-bearing activities or after changing to a harder walking surface. The pain initially occurs only with activity, but it can later occur at rest. Swelling or ecchymosis may be noted on examination, with point tenderness at the fracture site. A positive calcaneal squeeze test (i.e., pain on squeezing the sides of the calcaneus) suggests the diagnosis. Radiography often does not reveal a fracture, so bone scans, computed tomography, or MRI may be required. Activity modification, with little to no weight bearing for up to six weeks if pain is severe, is usually successful. Heel pads or walking boots can also be used. Calcaneal stress fractures tend to heal well in otherwise healthy patients.

• #42 Plantar Heel Pain Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1233178-workup

  Plain radiographs showing the lateral view of the calcaneus can be useful in detecting a stress fracture, which appears as a double-dense sclerotic line. […] Magnetic resonance imaging (MRI) can be used to confirm a diagnosis, such as a stress fracture, especially in the early stages before it is detectable with plain radiography. MRI is also used to investigate further for soft-tissue or bone lesions in the hindfoot. In persons with plantar fasciitis, this modality demonstrates edema and thickening of the plantar fascia, but MRI is not used to diagnose this condition.

• #43 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain accompanied by burning, tingling, or numbness may suggest a neuropathic etiology, either with nerve entrapment or the development of a neuroma. Nerve entrapment can be caused by overuse, trauma, or injury from a previous surgery. Neuropathic plantar heel pain typically involves branches of the posterior tibial nerve, the lateral plantar nerve, or the nerve to the abductor digiti minimi. Lumbar radiculopathy at the L4-S2 levels should also be considered regardless of the presence of associated low back pain. Neuropathic heel pain is usually unilateral, and underlying systemic disease should be ruled out in patients with bilateral pain. MRI and ultrasonography may be helpful in visualizing the nerve entrapment. Treatment initially involves rest, ice, use of anti-inflammatory or analgesic medications, relief of pressure at the pain site, and stretching. Surgical decompression should be considered if conservative treatment is ineffective.

• #44 Plantar Heel Pain Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1233178-workup

  Plain radiographs showing the lateral view of the calcaneus can be useful in detecting a stress fracture, which appears as a double-dense sclerotic line. […] Magnetic resonance imaging (MRI) can be used to confirm a diagnosis, such as a stress fracture, especially in the early stages before it is detectable with plain radiography. MRI is also used to investigate further for soft-tissue or bone lesions in the hindfoot. In persons with plantar fasciitis, this modality demonstrates edema and thickening of the plantar fascia, but MRI is not used to diagnose this condition.

• #45 How to diagnose plantar fasciitis | plantar fasciitis diagnosis

  https://www.fasciitis.com/plantar-fasciitis-diagnosis/

  An x-ray is generally not indicated in making the diagnosis of plantar fasciitis. However, X-rays are frequently done since they are simple and help in the overall evaluation of the foot. […] Ultrasound examination is an excellent diagnostic tool for plantar fasciitis involves no exposure to radiation and is thought to be as effective or even more effective than an MRI or bone scan in diagnosing plantar fasciitis. […] A Magnetic Resonance Image (MRI) is usually performed in cases of plantar fasciitis when conservative remedies are unsuccessful at managing heel pain usually after 4-6 months. Typical MRI findings that are characteristic of PF are: Generalized thickening of plantar fascia (anything exceeding 4mm is considered abnormal) […] There are a number of neurological and musculoskeletal conditions which can mimic the symptoms of plantar fasciitis and incorrect diagnosis can delay correct treatment.

• #46 Heel Pain Treatment & Reliefs | Diagnosis & Common Causes of Heel Pain

  https://footandankle-usa.com/specialty/plantar-fascia/

  Plantar Fasciitis is one of the most common causes of heel pain. […] X-Rays are taken to evaluate the heel bone for a spur and to rule out other pathology such as fractures. […] Ultrasound can be used as needed to assess the thickness of the plantar fascia and assess for any plantar fascia tears. […] Clinical examination will be done to assess the heel, foot, and also the achilles tendon which plays a significant role in the inflammation of the plantar fascia. […] Gait exam to evaluate and address the underlying biomechanical problems. […] Plantar Fasciitis can become a chronic condition if not treated. It is important to seek care when the problem first appears and to address the underlying cause rather than waiting for it to become worse. […] On examination, one can reproduce pain by pressing both under the heel as well as compressing the heel bone (calcaneus) from side to side. […] Other causes of heel pain include a fracture or bone tumor, so x-rays are usually performed in evaluating this condition.

• #47 Everyone With Heel Pain Does Not Have Plantar Fasciopathy – Just Ask Mr. Baxter — Physio Network

  https://www.physio-network.com/blog/heel-pain-not-plantar-fasciopathy/

  Plantar heel pain (PHP) is a common problem among adults. It can lead to severe pain which causes significant disability and impairment of activities of daily living. PHP can be due to local causes such as plantar fasciopathy, referred causes like S1 radiculopathy, or systemic illness like seronegative spondyloarthropathies (SpA) (2). […] The presence of a suspected compressive neuropathy may be confirmed by imaging and/or electromyography, but should be initially evaluated with a focused physical examination. In the case of Baxter neuropathy, the diagnosis is confirmed by magnetic resonance imaging (MRI) demonstrating atrophy of the abductor digiti quinti minimi muscle belly (4). […] Neuropathy of the Baxter nerve is described with prevalence between 1520% in the literature, and is very relevant among the PHP population in general and has been described to be the first cause of PHP with neurological origins. […] Not every patient with heel pain has Plantar fasciopathy. […] The differentials for heel pain are exhaustive and we as clinicians need to be better at listening to the patients story and most importantly validate their ideas, concerns and expectations.

• #48 Everyone With Heel Pain Does Not Have Plantar Fasciopathy – Just Ask Mr. Baxter — Physio Network

  https://www.physio-network.com/blog/heel-pain-not-plantar-fasciopathy/

  Plantar heel pain (PHP) is a common problem among adults. It can lead to severe pain which causes significant disability and impairment of activities of daily living. PHP can be due to local causes such as plantar fasciopathy, referred causes like S1 radiculopathy, or systemic illness like seronegative spondyloarthropathies (SpA) (2). […] The presence of a suspected compressive neuropathy may be confirmed by imaging and/or electromyography, but should be initially evaluated with a focused physical examination. In the case of Baxter neuropathy, the diagnosis is confirmed by magnetic resonance imaging (MRI) demonstrating atrophy of the abductor digiti quinti minimi muscle belly (4). […] Neuropathy of the Baxter nerve is described with prevalence between 1520% in the literature, and is very relevant among the PHP population in general and has been described to be the first cause of PHP with neurological origins. […] Not every patient with heel pain has Plantar fasciopathy. […] The differentials for heel pain are exhaustive and we as clinicians need to be better at listening to the patients story and most importantly validate their ideas, concerns and expectations.

• #49 Plantar Fasciitis Diagnosis

  https://www.sports-health.com/sports-injuries/ankle-and-foot-injuries/plantar-fasciitis-diagnosis

  Lab testing (e.g. testing a patients blood sample) is not considered routine, but it may be done to rule out systemic illness, such as rheumatoid arthritis. Some experts also suggest nerve testing, such as an electromyography (EMG), to rule out nerve disorders such as Baxters Neuropathy that may cause heel pain.

• #50 Heel Pain (including Plantar Fasciitis)

  https://patient.info/doctor/heel-pain

  Diagnostic studies for neurological heel pain include electromyography, nerve conduction studies and MRI scan. […] Systemic arthritic diseases may present with heel pain. These include the seronegative arthritides, psoriatic arthritis, reactive arthritis, diffuse idiopathic skeletal hyperostosis (DISH), rheumatoid arthritis, fibromyalgia and gout. […] Acute trauma to the calcaneus is the most common bone cause of heel pain. This usually occurs following a fall from a height on to the heel. […] Although rare, benign and malignant tumours, infection (soft tissue and bone) and vascular disease must be considered.

• #51 The Differential Diagnosis of Heel Pain (Best of 2015) | RheumNow

  https://rheumnow.com/content/differential-diagnosis-heel-pain-best-2015

  Nerve entrapment can be suggested by pain or associated neuropathic symptoms – burning, tingling, or numbness. […] Posterior heel pain can also be attributed to a Haglund deformity, a bony prominence over the superior posterior calcaneus that may lead to bursitis between the calcaneus and Achilles tendon. […] The diagnosis can be established by electrodiagnostic testing or Tinels sign (thumping over the posterior tibial nerve). […] Pain arise from the sinus tarsi that includes the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. […] Based on the above, her differential diagnosis may include calcaneal stress fracture, entrapment neuropathy (lateral plantar nerve) or the sinus tarsi syndrome.

• #52 Plantar Heel Pain Workup: Laboratory Studies, Imaging Studies

  https://emedicine.medscape.com/article/1233178-workup

  Generally, plantar fasciitis is a clinical diagnosis; laboratory and imaging studies are rarely indicated. However, heel pain, especially when it is bilateral, can be a rare primary presenting sign of systemic inflammatory disorders. If a patient presents with bilateral heel pain in association with systemic symptoms, the blood should be screened for inflammatory markers, such as the erythrocyte sedimentation rate (ESR), human leukocyte antigen (HLA)-B27, rheumatoid factor (RF), and antinuclear antibodies (ANA). […] Heel spurs develops in the origin of the flexor digitorum brevis in approximately 50% of patients with proximal plantar fasciitis. The etiology is thought to be repetitive traction that leads to collagen degeneration, angiofibroblastic hyperplasia, and matrix calcification. […] However, a report by Johal and Milner suggests a significant association between plantar fasciitis and calcaneal spur formation.

• #53 Heel Pain (including Plantar Fasciitis)

  https://patient.info/doctor/heel-pain

  Diagnostic studies for neurological heel pain include electromyography, nerve conduction studies and MRI scan. […] Systemic arthritic diseases may present with heel pain. These include the seronegative arthritides, psoriatic arthritis, reactive arthritis, diffuse idiopathic skeletal hyperostosis (DISH), rheumatoid arthritis, fibromyalgia and gout. […] Acute trauma to the calcaneus is the most common bone cause of heel pain. This usually occurs following a fall from a height on to the heel. […] Although rare, benign and malignant tumours, infection (soft tissue and bone) and vascular disease must be considered.

• #54 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain is a common presenting symptom to family physicians and has an extensive differential diagnosis. Most diagnoses stem from a mechanical etiology. A thorough patient history, physical examination of the foot and ankle, and appropriate imaging studies are essential in making a correct diagnosis and initiating proper management. The history should provide information about the onset and characteristics of the pain, alleviating or exacerbating factors, changes in activity, and other related conditions. […] The anatomic location of the pain can be a guide to diagnosis. Examination should include inspection of the foot at rest and when weight bearing, as well as palpation of bony prominences, tendon insertions, and the foot and ankle joints. Any tenderness, defects, or differences between the sides should be noted. Active range of motion of the foot and ankle should be assessed; if full range of motion is not present, passive range of motion should also be evaluated. Specific testing, as detailed throughout this article, will also help determine the diagnosis.

• #55 Windlass Test | Plantar Fasciitis Assessment | Heel Pain Exam

  https://www.physiotutors.com/wiki/windlass-test/

  The Windlass Test is a common orthopedic test to assess for plantar fasciitis, which is one of the leading causes of heel pain next to Achilles tendinopathy. […] De Garceau et al. (2003) found a sensitivity of 32 % and a Specificity of 100% for this test in the diagnosis of plantar fasciitis. […] This means that this test is not useful to exclude the presence of plantar fasciitis, but very useful to confirm the suspected pathology. […] This test is positive if the patient feels pain or increased pain at the insertion of the plantar fascia at the head of the first metatarsal. […] If the extension is not possible at the MTP joint this may indicate a Hallux Rigidus. […] It can be interesting to perform the Navicular Drop Test which assesses overpronation of the subtalar joint, which can be a contributing factor to plantar fasciitis. […] The association between diagnosis of plantar fasciitis and Windlass test results.

• #56 Windlass Test | Plantar Fasciitis Assessment | Heel Pain Exam

  https://www.physiotutors.com/wiki/windlass-test/

  The Windlass Test is a common orthopedic test to assess for plantar fasciitis, which is one of the leading causes of heel pain next to Achilles tendinopathy. […] De Garceau et al. (2003) found a sensitivity of 32 % and a Specificity of 100% for this test in the diagnosis of plantar fasciitis. […] This means that this test is not useful to exclude the presence of plantar fasciitis, but very useful to confirm the suspected pathology. […] This test is positive if the patient feels pain or increased pain at the insertion of the plantar fascia at the head of the first metatarsal. […] If the extension is not possible at the MTP joint this may indicate a Hallux Rigidus. […] It can be interesting to perform the Navicular Drop Test which assesses overpronation of the subtalar joint, which can be a contributing factor to plantar fasciitis. […] The association between diagnosis of plantar fasciitis and Windlass test results.

• #57 Windlass Test | Plantar Fasciitis Assessment | Heel Pain Exam

  https://www.physiotutors.com/wiki/windlass-test/

  The Windlass Test is a common orthopedic test to assess for plantar fasciitis, which is one of the leading causes of heel pain next to Achilles tendinopathy. […] De Garceau et al. (2003) found a sensitivity of 32 % and a Specificity of 100% for this test in the diagnosis of plantar fasciitis. […] This means that this test is not useful to exclude the presence of plantar fasciitis, but very useful to confirm the suspected pathology. […] This test is positive if the patient feels pain or increased pain at the insertion of the plantar fascia at the head of the first metatarsal. […] If the extension is not possible at the MTP joint this may indicate a Hallux Rigidus. […] It can be interesting to perform the Navicular Drop Test which assesses overpronation of the subtalar joint, which can be a contributing factor to plantar fasciitis. […] The association between diagnosis of plantar fasciitis and Windlass test results.

• #58 08. Approach to Foot Pain | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/08-approach-foot-pain/08-approach-foot-pain

  History severe, burning or lancinating pain on the bottom of the foot at the arch or inferior heel. Often the pain is worse in the morning on arising and after period of inactivity. It improves with walking, though may return later in the day. […] Exam palpation over the plantar fascia’s insertion on the calcaneus (anteromedial heel) elicits pain. If the pain worsens when the examiner dorsiflexes the foot while palpating, the diagnosis is more specific. Radiographs do not aid in the diagnosis (heel spurs may be seen but itself do not contribute to pain). […] Treatment Most importantly, rest for several days to reduce inflammation. Stretch, strengthen, ice, massage and NSAIDs as first line. Arch supports to unload the fascia and heel cups for cushioning. Nighttime splints to keep ankle at 90 degrees, arch taping and PT may also help. Weight loss if obese.

• #59 08. Approach to Foot Pain | Hospital Handbook

  https://hospitalhandbook.ucsf.edu/08-approach-foot-pain/08-approach-foot-pain

  History severe, burning or lancinating pain on the bottom of the foot at the arch or inferior heel. Often the pain is worse in the morning on arising and after period of inactivity. It improves with walking, though may return later in the day. […] Exam palpation over the plantar fascia’s insertion on the calcaneus (anteromedial heel) elicits pain. If the pain worsens when the examiner dorsiflexes the foot while palpating, the diagnosis is more specific. Radiographs do not aid in the diagnosis (heel spurs may be seen but itself do not contribute to pain). […] Treatment Most importantly, rest for several days to reduce inflammation. Stretch, strengthen, ice, massage and NSAIDs as first line. Arch supports to unload the fascia and heel cups for cushioning. Nighttime splints to keep ankle at 90 degrees, arch taping and PT may also help. Weight loss if obese.

• #60 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Calcaneal stress fractures are caused by repetitive overload to the heel and most commonly occur immediately inferior and posterior to the posterior facet of the subtalar joint. Pain usually begins after an increase in weight-bearing activities or after changing to a harder walking surface. The pain initially occurs only with activity, but it can later occur at rest. Swelling or ecchymosis may be noted on examination, with point tenderness at the fracture site. A positive calcaneal squeeze test (i.e., pain on squeezing the sides of the calcaneus) suggests the diagnosis. Radiography often does not reveal a fracture, so bone scans, computed tomography, or MRI may be required. Activity modification, with little to no weight bearing for up to six weeks if pain is severe, is usually successful. Heel pads or walking boots can also be used. Calcaneal stress fractures tend to heal well in otherwise healthy patients.

• #61 FORUM CATEGORIES

  https://www.kevinrootmedical.com/community/xenforum/topic/113288/plantar-heel-pain-a-case-study

  A 47 year old female presents to the clinic complaining of pain on the bottom of the left heel. […] Preliminary diagnosis of plantar fasciitis/fasciosis/fasciopathy, left foot is made. […] The patient is counseled on the likely etiology of the condition and possible treatment options that are available. […] During physical exam of the heel, if it is tender when pinching the Calcaneal tuberosity area from side to side is suspect Calcaneal BME. […] If there is a palpable thickening of the proximal plantar fascia compared to the other side then suspect partial or complete tearing of the fascia. […] Also, with the advent of digital radiography, the shadow of the plantar fascia is often present on the lateral view, and thickening could be visible. […] A walking boot would generally control the pain in short order and minimize down time so it was generally accepted by the patients, especially if they had been suffering for a prolonged period of time.

• #62 Heel Pain Diagnosis and Management – Thrive Chiropractic & Health Clinic

  https://thriveforhealth.co.uk/heel-pain-diagnosis-and-management/

  Heel pain diagnosis requires an assessment of prior medical history and clinical examination. […] The patient’s medical history helps the doctor understand what could be the etiology of the heel pain. […] The patient’s history allows the physician to comprehend the nature of the pain and activities that trigger the pain. […] The medical examination helps to prove that the suspected problem is the cause of heel pain. […] A positive tinel test on the heel, particularly on the distal nerve, signifies tarsal tunnel or calcaneal nerve entrapment. […] Heel pain treatment range from conservative management to surgery.

• #63 Everyone With Heel Pain Does Not Have Plantar Fasciopathy – Just Ask Mr. Baxter — Physio Network

  https://www.physio-network.com/blog/heel-pain-not-plantar-fasciopathy/

  Plantar heel pain (PHP) is a common problem among adults. It can lead to severe pain which causes significant disability and impairment of activities of daily living. PHP can be due to local causes such as plantar fasciopathy, referred causes like S1 radiculopathy, or systemic illness like seronegative spondyloarthropathies (SpA) (2). […] The presence of a suspected compressive neuropathy may be confirmed by imaging and/or electromyography, but should be initially evaluated with a focused physical examination. In the case of Baxter neuropathy, the diagnosis is confirmed by magnetic resonance imaging (MRI) demonstrating atrophy of the abductor digiti quinti minimi muscle belly (4). […] Neuropathy of the Baxter nerve is described with prevalence between 1520% in the literature, and is very relevant among the PHP population in general and has been described to be the first cause of PHP with neurological origins. […] Not every patient with heel pain has Plantar fasciopathy. […] The differentials for heel pain are exhaustive and we as clinicians need to be better at listening to the patients story and most importantly validate their ideas, concerns and expectations.

• #64 Heel Pain: Diagnosis and Management | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p86.html

  Heel pain accompanied by burning, tingling, or numbness may suggest a neuropathic etiology, either with nerve entrapment or the development of a neuroma. Nerve entrapment can be caused by overuse, trauma, or injury from a previous surgery. Neuropathic plantar heel pain typically involves branches of the posterior tibial nerve, the lateral plantar nerve, or the nerve to the abductor digiti minimi. Lumbar radiculopathy at the L4-S2 levels should also be considered regardless of the presence of associated low back pain. Neuropathic heel pain is usually unilateral, and underlying systemic disease should be ruled out in patients with bilateral pain. MRI and ultrasonography may be helpful in visualizing the nerve entrapment. Treatment initially involves rest, ice, use of anti-inflammatory or analgesic medications, relief of pressure at the pain site, and stretching. Surgical decompression should be considered if conservative treatment is ineffective.

• #65 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #66 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #67 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #68 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #69 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #70 Diagnosis of Conditions Causing Heel Pain

  https://www.arcadiafootandankle.com/blogs/item/191-diagnosis-of-conditions-causing-heel-pain

  Diagnosing the cause of heel pain usually involves a comprehensive approach to identify the underlying issue accurately. First, a podiatrist will conduct a detailed medical history and physical examination, focusing on the foot to assess pain location, tenderness, and the presence of any swelling or abnormalities. The doctor may ask about the type of pain experienced, its onset, and any activities that exacerbate or relieve it. To further pinpoint the cause of heel pain, imaging tests such as X-rays, MRI scans, or ultrasounds may be utilized. These tools help a podiatrist visualize the internal structure of the foot, revealing issues like plantar fasciitis, heel spurs, or other soft tissue injuries. In certain cases, blood tests might be ordered to rule out systemic conditions, such as arthritis or gout, that can cause heel pain. Through this process, podiatrists can determine the specific cause of heel pain, allowing them to devise a targeted treatment plan that addresses the root of the problem.

• #71 Heel pain: a practical approach

  https://www.racgp.org.au/afp/2015/march/heel-pain-a-practical-approach

  Clinical assessment remains the most important diagnostic tool as imaging identifies pathology and structural abnormality. However, tendon and joint pathology can be present without pain. Therefore, pathology on imaging can mislead the clinician into thinking that imaging has confirmed the source of pain. Common examples include the presence of an os trigonum and heel spurs at the attachment of the plantar fascia and peroneal tendon pathology, seen as an increased signal on magnetic resonance imaging (MRI), which is common following an ankle inversion injury. […] Heel pain is usually of mechanical origin and the most valuable approach for the clinician is to use the site of pain to narrow potential diagnoses. Imaging can assist, however should not replace clinician assessment. Treatments vary with presentation and require thoughtful prescription.

• #72 Heel pain: a practical approach

  https://www.racgp.org.au/afp/2015/march/heel-pain-a-practical-approach

  Clinical assessment remains the most important diagnostic tool as imaging identifies pathology and structural abnormality. However, tendon and joint pathology can be present without pain. Therefore, pathology on imaging can mislead the clinician into thinking that imaging has confirmed the source of pain. Common examples include the presence of an os trigonum and heel spurs at the attachment of the plantar fascia and peroneal tendon pathology, seen as an increased signal on magnetic resonance imaging (MRI), which is common following an ankle inversion injury. […] Heel pain is usually of mechanical origin and the most valuable approach for the clinician is to use the site of pain to narrow potential diagnoses. Imaging can assist, however should not replace clinician assessment. Treatments vary with presentation and require thoughtful prescription.

• #73 Plantar fasciitis – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/diagnosis-treatment/drc-20354851

  Plantar fasciitis is diagnosed based on your medical history and physical exam. During the exam, your health care professional will check for areas of tenderness in your foot. The location of your pain can help determine its cause. […] Usually no tests are needed. Your health care professional might suggest an X-ray or MRI to make sure another problem, such as a stress fracture, is not causing your pain. […] Sometimes an X-ray shows a piece of bone sticking out from the heel bone. This is called a bone spur. In the past, these bone spurs were often blamed for heel pain and removed surgically. But many people who have bone spurs on their heels have no heel pain. […] Your health care professional might refer you to someone who specializes in foot disorders or sports medicine. […] For plantar fasciitis, basic questions to ask your health care team include: What tests do I need? […] Your health care professional is likely to ask you questions, such as: What types of shoes do you usually wear?

• #74 10 Causes of Heel Pain and When to See a Doctor | Raleigh Orthopaedic

  https://www.raleighortho.com/blog/foot-and-ankle/10-heel-pain-causes-and-when-to-see-a-doctor-part-1/

  Heel pain is a common symptom that has many possible causes. […] If you are unsure of the cause of your symptoms, or if you do not know the specific treatment recommendations for your condition, seek medical attention. […] If you have suffered from heel pain, its almost impossible to diagnose yourself. […] So the best thing you can do is visit a foot and ankle specialists in Cary or a location convenient for you to get medical advice and consultation. […] Here are some definite signs that you should be evaluated by a doctor: Inability to walk comfortably on the affected side, Heel pain that occurs at night or while resting, Heel pain that persists beyond a few days, Swelling or discoloration of the back of the foot, Signs of an infection, including fever, redness, and warmth, Any other unusual symptoms. […] The Raleigh Orthopaedic Clinics board-certified, fellowship-trained foot and ankle specialists bring together many years of experience to diagnose, manage and correct various foot conditions.

• #75 Heel Pain: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/heel-pain

  Heel pain is a very common foot and ankle problem. You might experience pain, soreness or tenderness anywhere in your heel, but the most common areas are underneath it or the back of it. […] Its important to see your healthcare provider to help you determine the exact cause of pain in the heel of your foot. Most heel conditions improve with nonsurgical treatments, but your body will need time to recover. […] Your healthcare provider will assess your symptoms and perform a physical exam. You may also get X-rays to check for arthritis, bone fractures, bone misalignment and joint damage. […] Most problems that cause heel pain get better over time with nonsurgical treatments. Heel pain treatment focuses on easing pain and inflammation, improving foot flexibility and minimizing stress and strain on your heel. […] Its rare to need surgery to treat most causes of heel pain. […] Heel pain often improves over time with nonsurgical treatments. Your healthcare provider can determine whats causing the pain. Your provider can also show you stretching exercises and recommend orthotics and other methods if needed.

• #76 Diagnosis and Management of Plantar Fasciitis

  https://www.degruyterbrill.com/document/doi/10.7556/jaoa.2014.177/html?lang=en&srsltid=AfmBOoqrfL6emNPiTk8gs9_9lXKHf56yZmx28gH00QyYOxnzMMsKEmEl

  Plantar fasciitis is one of the most common causes of heel pain. […] The diagnosis is often made clinically based on the location of pain at the medial calcaneal tubercle. […] Imaging may be necessary to rule out other causes of heel pain in the differential diagnosis after nonsurgical treatment has failed or after the patient presents with atypical pain. […] A combination of conservative treatments is successful in most cases and should include NSAIDs, a proper stretching regimen, night splints, and, if there is no relief after 6 to 12 months, referral to a specialist. […] Surgical treatment should only be considered if all other methods fail.

• #77 Heel pain: Diagnosis and treatment, step by step | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/73/5/465

  The differential diagnosis of heel pain is broad and can be overwhelming if a systematic approach is not used. […] Focused questions and physical examination can help identify heel pain as Achilles tendinopathy or plantar fasciitis, or as due to a less common cause such as gout, spondyloarthropathy, or hypercholesterolemia.

• #78 Heel pain: Diagnosis and treatment, step by step | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/73/5/465

  The differential diagnosis of heel pain is broad and can be overwhelming if a systematic approach is not used. […] Focused questions and physical examination can help identify heel pain as Achilles tendinopathy or plantar fasciitis, or as due to a less common cause such as gout, spondyloarthropathy, or hypercholesterolemia.

• #79 Heel pain: a practical approach

  https://www.racgp.org.au/afp/2015/march/heel-pain-a-practical-approach

  Heel pain is a common presentation in primary care and the risk of developing pain is higher with increasing body mass index and age. This article aims to assist with differential diagnosis of heel pain, which is critical as there are many structures in the heel area that can cause pain, and each requires a tailored treatment. The use of diagnostic imaging must be considered in the context of clinical presentation as asymptomatic pathology occurs in many tissues. Evidence-based treatment for common causes of heel pain are limited. As with all presentations to clinicians, the potential for non-musculoskeletal, more sinister causes of pain and systemic disease must be considered. […] Heel pain is a vague term describing pain surrounding the calcaneus, most commonly felt posteriorly or inferiorly. However, patients consider a more broad area as their heel. This review, therefore, will consider the structures that may cause pain from the calcaneus, extending to both lateral and medial perimalleolar regions, the Achilles enthesis and proximal plantar fascia attachment. Most pain arises from pathology in soft tissue structures (tendons, fascia and nerves); apophyses and other sources of bony pain are less common. As with other soft tissue structures, pathology on imaging is not always correlated with pain and a good clinical examination is required to reveal the painful structure.

• #80 How Is Heel Pain Diagnosed? | The Podiatry Group of South Texas

  https://www.thepodiatrygroup.com/2022/05/31/how-is-heel-pain-diagnosed/

  Heel pain is a common occurrence in the United States, significantly interfering with your ability to walk, work, exercise, and perform daily tasks. […] In this regard, visiting a podiatrist will be your best choice to receive a diagnosis of heel pain, as they are experts at diagnosing and treating your foot and ankle problems. […] A podiatrist will diagnose your heel pain in different steps that may include: […] Firstly, your podiatrist will ask for and assess your symptoms, such as pain, soreness, and tenderness anywhere in your heel. […] A podiatrist will also take your medical history and ask about your lifestyle and work habits. […] Since the anatomical position of your heel pain can help with diagnosis, your podiatrist will inspect your foot in both rest and weight-bearing positions.

• #81 Not all heel pain is Plantar Fasciitis! – RunningPhysio

  https://www.running-physio.com/pf-differentials/

  While Plantar Fasciitis is common its not the only cause of heel pain! […] Its important we recognise differential diagnosis in this region as it can affect treatment and outcomes for patients. […] In our video below I explore sites of symptoms for other causes of heel pain and discuss 3 case studies where a different diagnosis was missed and how this influence management. […] Low-dye taping has been recommended as a core treatment in PHP (Morrissey et al. 2021) but it should be combined with individualised education and exercises (such as stretching or progressive strength work). […] The choice of whether to try tape (and which to choose) should be made based on individual needs and preferences.

• #82 Not all heel pain is Plantar Fasciitis! – RunningPhysio

  https://www.running-physio.com/pf-differentials/

  While Plantar Fasciitis is common its not the only cause of heel pain! […] Its important we recognise differential diagnosis in this region as it can affect treatment and outcomes for patients. […] In our video below I explore sites of symptoms for other causes of heel pain and discuss 3 case studies where a different diagnosis was missed and how this influence management. […] Low-dye taping has been recommended as a core treatment in PHP (Morrissey et al. 2021) but it should be combined with individualised education and exercises (such as stretching or progressive strength work). […] The choice of whether to try tape (and which to choose) should be made based on individual needs and preferences.

• #83 Heel pain: Causes, prevention, and treatments

  https://www.medicalnewstoday.com/articles/181453

  Heel pain can result from factors like inflammation, bone changes, and nerve compression. It occurs under the heel or just behind it, where the Achilles tendon connects to the heel bone. Sometimes, it can affect the side of the heel. […] Pain that occurs under the heel is likely due to plantar fasciitis. This is the most common cause of heel pain. Pain behind the heel is most likely Achilles tendinitis. Pain can also affect the inner or outer side of the heel and foot. […] A doctor will examine the foot and ask about the pain, the amount of walking and standing the person does, and what type of footwear the person uses. They will also ask about the persons medical history. […] An accurate diagnosis is more likely to lead to effective treatment.

• #84 Heel Pain: Causes, Diagnosis & Treatment

  https://my.clevelandclinic.org/health/symptoms/heel-pain

  Heel pain is a very common foot and ankle problem. You might experience pain, soreness or tenderness anywhere in your heel, but the most common areas are underneath it or the back of it. […] Its important to see your healthcare provider to help you determine the exact cause of pain in the heel of your foot. Most heel conditions improve with nonsurgical treatments, but your body will need time to recover. […] Your healthcare provider will assess your symptoms and perform a physical exam. You may also get X-rays to check for arthritis, bone fractures, bone misalignment and joint damage. […] Most problems that cause heel pain get better over time with nonsurgical treatments. Heel pain treatment focuses on easing pain and inflammation, improving foot flexibility and minimizing stress and strain on your heel. […] Its rare to need surgery to treat most causes of heel pain. […] Heel pain often improves over time with nonsurgical treatments. Your healthcare provider can determine whats causing the pain. Your provider can also show you stretching exercises and recommend orthotics and other methods if needed.

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