The Hip: Preservation, Replacement and Revision

Heel Pain



- Diff Dx:
     - distal tibial tarsal tunnel syndrome;
           - expect tenderness superior to the origin of the plantar fascia (medial tubercle of os calcis);
     - plantar fascitis
           - expect tenderness at the origin of the plantar fascia (medial tubercle of os calcis);
     - calcaneal apophysitis
     - heel pain syndrome
     - systemic syndromes:
             - metabolic: gout and pseudogout;
             - diabetes:
             - Paget's disease:
             - inflammatory arthritides (RA, Reiter's Syndrome, AS, Psoriatic arthritis, ...)
     - neoplastic: benign and malignant tumours:
     - trauma:
             - fat pad trauma: symptoms may last well over 6 months;
             - stress fracture (identified on 45 deg medial oblique view)
             - acute fracture
             - soft tissue contusion / repetitive trauma;
             - puncture wound
     - fat pad atrophy:
             - heel pad has a specialized anatomy with small chambers of adipose tissue divided by fibrous septae,
                     but there are no documented changes in heel pain patients)


- Lab studies: (useful to r/o RA or Reiter's)
    - ESR;
    - RF;
    - Uric acid;


- X-rays:
    - may demonstrate spurring of the medial calcaneal tuberosity;
    - heel spurs are not in the plantar fascia as is commonly thought but are found in the origin of the short flexors;
           - they are present in 16% of normal population


- Orthotics:
    - with plantar heel tenderness consider a cushioned heel insert, to lessen the loading forces during heel strike



Chronic heel pain. Treatment rationale.



Original Text by Clifford R. Wheeless, III, MD.

Last updated by Data Trace Staff on Wednesday, May 23, 2012 1:26 pm