Plantar fasciitis is the number one cause of heel pain at the bottom of the foot, but it is possible to have these three other heel disorders. If you have not heard of plantar fasciitis, then follow this treatment guide first:
Neurologic heel pain is usually due to an irritated or an entrapped nerve through a region that is prone to constriction and tightness such as the ankle joint or in the back where the nerve exits the spine. This type of pain may easily mimic plantar fasciitis (painful bottom of the heel) or back of the heel pain (Achilles tendinopathy) or inside of the ankle pain.
This type of pain usually manifests itself as numbness, tingling or burning pain rather than the aching sore pain that is experienced with muscle soreness.
-The type of nerve pain originating around the ankle joint is referred to as tarsal tunnel syndrome which is essential the equivalent of carpal tunnel syndrome that is found in the wrist.
-Nerve pain can also occur much earlier and closer to the spine and can be associated with back pain or injury. If you have recently injured your back or have had back pain, a slipped disc or anything like that, then you should suspect what is known as radiculopathy (nerve pain originating from the nerve root in the spine)
-It is also possible to have the nerve irritated in both the back and in the ankle.
-Nerves may also be irritated due to obesity, venous problems (swollen varicose veins), trauma, and space occupying masses.
-Nerve pain can also occur due to systemic disease such as diabetes, nutritional or vitamin deficiencies or alcoholism.
-Tests for neurologic nerve pain include electromyography, nerve conduction velocity, MRI and pressure specified sensory device testing which can be done by your podiatrist.
Treatment for neurological nerve problems includes:
-Release of the nerve entrapment either at the back or around the ankle and plantar fascia
-Nerve release of the tarsal tunnel to prevent tarsal tunnel syndrome
-Medical treatment of peripheral neuropathy through medications
-Almost all cases of heel pain are at least partially mechanically related and will respond to the following recommended therapy, even if inflammatory arthritis is present, but it is good know if any additional modifications can be made to the treatment regimen.
Keep in mind the possibility of:
Serognegative arthritides like psoriatic arthritis, ankylosing spondylitis, Reiter’s disease, diffuse idiopathic skeletal hyperostosis, rheumatoid arthritis, fibromyalgia and previous cases of gout.
-Evaluation for these arthritides would require x-ray and laboratory testing by your podiatrist
Treatment of these would include the following”
-Consult with a rheumatological specialist
While biomechanical damage over time is the most common form of soft tissue injury to the plantar fascia and the Achilles tendon around the heel, a traumatic injury to the heel bone itself is the most common cause of a bone injury in the heel region.
The main thing is recognizing that a high impact fall can translate into the ankle or the mid-foot as spread out pain that is not localized, or it could even have injured your back and compressed nerves that are leading down to your foot and ankle.
It is important to diagnose this type of pain because over time as you think that it will get better, the small little fragments will develop into arthritis and inhibit joint motion permanently.
Treatment for this type of traumatic injury:
-Get it diagnosed properly with history and X-rays
-Immobilization will likely be needed to prevent the development of arthritis
-Surgery may be necessary to excise broken bone fragments or re-attach pieces if they are large enough or serious enough