Heel Pain Differential Diagnosis
Welcome to the differential diagnosis guide for heel pain- I am basing a large part of this from the guide made by ACFAS & supplementing from other treatment guidelines based on what is most practical.
Table of Contents
Heel Pain has 1 major cause and 4 minor causes:
Major Cause of all heel pain is Mechanical heel pain – The overwhelming cause is due to biomechanical problems – this is any problem that can lead to the gradual overworking and overstretching of the plantar fascia. These are causes like obesity, poor footwear choices, standing and walking on your feet too much and poor biomechanics. Other minor causes of heel pain– Neurological causes, Arthritic causes, Traumatic causes & Other types
1)Mechanical Heel Pain
– This group includes plantar fasciitis, plantar fasciosis and heel spur syndrome
-Heel pain is the most common problem seen by foot and ankle specialists. Plantar fasciitis and heel spur syndrome are essentially the same thing but a spur may be absent in fasciitis(the spur is usually not what is causing the pain), the term fasciosis indicates that there is less inflammation and it has progressed to just degenerating at this point.
-Overworking the fascia through biomechanical irregularities, obesity or simply standing too much leads to inflammation and microscopic tearing in the fascia. This leads to pain the morning upon and after periods of rest, but as you walk around the pain usually decreases.
More likely mechanical heel pain if:
- A high BMI, tight Achilles tendon, poor choices in footwear
Less likely mechanical heel pain if:
- Radiating numbness burning and tingling (more likely a nerve problem)
- Decreased or absent normal joint range of motion- especially ankle dorsiflexion (likely arthritis)
- Presence of hyperesthesia or dysthesias (nerve problem)
- Decreased fat pad or fat pad atrophy (fat pad contusion)
- If you suffered and injury (traumatic injury)
- The heel went from feeling great to feeling awful in a short period of time.
Home Treatment Guide for Mechanical Heel Pain:
The length of time you had the pain is proportional to how long it will take to treat the pain.
We have developed a 4 stage treatment plan that should guide you through to the complete treatment of your heel pain.
If you suspect that your heel pain is not caused by mechanical causes, then your best bet is to go see your podiatrist at this point.
Neurological causes- If radiating, sharp, shooting pain and numbness in your feet
Arthritic causes – more likely if you are suffering from bilateral plantar fasciitis, if you have a history of rheumatoid arthritis, psoriasis or any other inflammatory arthritis or ankylosing spondylitis.
Traumatic causes- If you landed on your heel previously and it has led to aching pain, if you have been running heavily and your heel starts to hurt more after activity, if the pain has onset heavily one day after not hurting before.
Calcaneal Stress Fracture – Pain gets worse the more you walk on it- especially barefoot on a hard surface
Nerve entrapment- burning, numbness and tingling pain rather than deep aching pain.
Heel Pad Contusion- deep bruising pain in the middle of the heel
Tarsal Tunnel Syndrome- numbness, burning and tingling on the inside of the ankle as well
Achilles tendinitis- in the back of the heel