Plantar heel pain is the most common musculoskeletal foot condition treated by health professionals (1) at large. In many cases, plantar heel pain has debilitating impacts on an individuals quality of life and Physical Freedom.
The ramifications of ignoring heel pain can impact physical Freedom from months to years. At the Foot & Leg Pain Centre, we are specific in identifying the underlying diagnosis of your heel pain. Far too often, we hear the flippant diagnosis of heel spur syndrome or plantar fasciitis. X-rays are usually unnecessary in the case of heel spurs as they are considered normal in individuals over 35 years.
Plantar heel pain due to plantar fasciitis rarely heals itself. Hansen, Krogh (2) followed 174 plantar fasciitis sufferers for 15 years and found between 44-50% of them continued to suffer symptoms at 5, 10 and 15-year follow-up.
Plantar heel pain may occur acutely with heel bruising (contusions), plantar fascial strain, tear or bursitis. These conditions would likely have a sudden onset and should be treated with aggressive immobilisation in the short term to avoid longer-term conditions.
Chronic plantar heel pain may include diagnoses of plantar heel spur syndrome, plantar fascial enthesopathy, or fibrosis of the plantar fascia where bumps develop within the plantar fascia (plantar fascial fibroma). Alternatively, those suffering pain at the back of the heel may have posterior heel spurs, where the achilles tendon calcifies (turns into bone) at the insertion into the heel. Other posterior heel pains may relate to achilles enthesopathy, Os-Trigonum, and or retrocalcaneal bursitis.
Recacitarnt plantar heel pain may be of neural origin. (3) Nerve impingement involving the Baxters Nerve, medial, lateral calcaneal or sural nerves (4) can result in stinging, the sensation of standing on glass or glass, worsening as the day goes on.
The good news is, in our extensive experience, these conditions often respond well to conservative treatment. At the Foot & Leg Pain Centre, we start with a thorough dynamic and static assessment to clearly identify the specific condition your heels are suffering. Then, if necessary, ultrasound, X-rays, and MRI can be ordered for a definitive diagnosis. With a clear diagnosis of your symptoms and thorough assessment, the benefits of treatments can be quickly realised.
References
- McPoil TG, Martin RL, Cornwall MW, Wukich DK, Irrgang JJ, Godges JJ. Heel Pain—Plantar Fasciitis. J Orthop Sports Phys Ther. 2008;38(4):A1-A18.
- Hansen L, Krogh TP, Ellingsen T, Bolvig L, Fredberg U. Long-term prognosis of plantar fasciitis: a 5-to 15-year follow-up study of 174 patients with ultrasound examination. Orthopaedic journal of sports medicine. 2018;6(3):2325967118757983.
- Barrett S. When Is Heel Pain Nerve Pain? Podiatry Today. 2016.
- Alshami AM, Souvlis T, Coppieters MW. A review of plantar heel pain of neural origin: Differential diagnosis and management. Manual Therapy. 2008;13(2):103-11.
