Can Heel Pain Be Something Other Than Plantar Fasciitis?
After over 30 years of practice, I would venture to say that the most common diagnosis of heel pain is plantar fasciitis. However, many times after examination, I’ve found out it is something else. It is also possible that there are other conditions in conjunction with the plantar fasciitis. If the exact diagnosis and reason it came about is unknown, it may affect the treatment plan/success. Determining all conditions involved will help save time and money by avoiding unnecessary shot gun cookie cutter treatments.
Typical plantar fasciitis is caused by abnormal pulling and stretching of the fascia within and at the heel bone. This results in post static dyskinesia (pain after sitting or resting) in the arch or heel. However, other conditions may cause similar symptoms. Remember, all heel pain is not alike.
Common conditions I’ve seen with heel pain are:
- Fat Pad Atrophy
- Inflamed Bursitis within the Fat Pad
- Inflamed Nerve-a palpable cord like structure across the bottom of the heel bone
- Fat Pad Looseness and Displacement
- Posterior Tibial Tendonitis
- Tarsal Tunnel Syndrome- compression of the nerve at the inside of the ankle.
All may exhibit plantar heel pain (bottom of the heel) but it is not the fascia. Other possibilities, yet rare are pain from a heel spur, arthritis, a stress fracture, bone or soft tissue tumor or skin condition.
One example comes to mind is a patient was told to lose weight. This may be a good idea for their health but too fast of loss can lead to atrophy of the fat pad on the bottom of the heel. I frequently hear “I never had heel pain till I lost 50 pounds.” Being overweight and obesity are usually not the main cause of heel pain.
Each diagnosis may require a different treatment. Utilizing the same treatment for every heel pain patient can lead to wasted time and money. If quickly told to “Try a heel pad or gel pad,” it may help for the above fat pad atrophy patient but not much for the posterior tibial tendonitis patient.
We are all different; therefore, treatment plans are best when geared to eliminating not only the pain but also the cause of the specific diagnosis.
Finally, it is interesting to find, many of the conditions can be successfully treated with the ideal fit and structured shoe as well as some type of “Arch Support.” Biomechanics does play a large role. But remember, what helped one may not help you. So, you may try some simple inexpensive things but do not keep wasting time and money on “This or That” treatment, especially when claimed to be “Clinically” proven.
David J. Sables, D.P.M., C.Ped
Former Foot Surgeon Specializing in Biomechanical Treatment