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Plantar Heel Pain

June 5, 2017

Updated: July 2017

 

Overview:

Plantar fasciitis is pain associated with the plantar fascia, a band of connective tissue that runs from under the heel to the ball of the foot.

 

 

It’s often called a stone bruise or a heel spur.

 

The average length of symptoms for people with plantar fasciitis is 13 to 14 months [1].

 

 

See this blog for more detailed treatment options.

Clinical Presentation:

You usually present with one or more of the following:

  • Pain when first standing or walking after a period of rest, often when you first get out of bed in the morning. [1]

  • The pain usually settles or reduces after 5-10 minutes of walking. [1]

  • The pain may be worse the next day or at the end of the day if you’ve been standing or walking a lot.

  • There maybe a recent increase in standing especially on a hard surface or increase in walking before the pain began [1]

  • Most common in people over the age of 40 [2]

  • Only 1 heel is sore (can be left or right) 7 in 10 [2]

Different Causes:

Not all plantar heel pain is caused by plantar fasciitis, different causes for your heel pain include:

  • The fat pad becoming thinner under your heel – less natural padding can cause pain when standing on hard surfaces [1]

  • Fibrous lumps in the plantar fascia (plantar fibromas) can give you the feeling of walking on a stone [1]

  • Systemic joint inflammation such as spondyloarthritis [1] (also called seronegative arthritis), psoriatic arthritis, rheumatoid arthritis, fibromyalgia or gout [3]

  • Compression of the sciatic nerve in the lower back causing altered messages to come from the sensory nerves at the heel [3]

  • Compression of the nerve behind your ankle joint on the inside of your foot (also called tarsal tunnel syndrome) or the nerve under your heel [3]

  • A tear in the plantar fascia, usually along the length and more rarely across the width [3]

Investigations:

Plantar fasciitis is diagnosed by the history of pain you describe and the results of a physical examination, there usually isn’t a need for further investigations.

 

If you don’t describe a typical history or there are other findings during the physical examination or initial treatment doesn't help as much as we expect, there may be other causes for your heel pain.

 

The following investigations may help confirm you do or don’t have plantar fasciitis:

  • Ultrasound – helps confirm plantar fasciitis due to thickening of the plantar fascia. Can also help diagnose fascia tears and plantar fibromas. [4]

  • X-ray – will often show a heel spur but this usually isn’t the cause of your heel pain.  Can also help diagnose heel spur fractures, systemic joint inflammation conditions and other changes in the heel bone [4]

  • MRI – if you’ve had your pain longer than 6 months and treatment hasn’t reduced your pain and an x-ray and ultrasound don’t show anything besides plantar fasciitis then an MRI should be considered.  MRI can help see swelling inside the heel bone called bone oedema

  • Blood tests – help diagnose systemic joint inflammation conditions [3]

Treatment:

See this blog for more detailed treatment options.

 

Disclaimer:

Inform Podiatry develops information sheets to provide general advice.  Please see Inform Podiatry for an individual assessment, diagnosis and management plan for your condition.

References:
[1] Martin RL, et al, "Heel Pain—Plantar Fasciitis: Revision 2014 Clinical Practice Guidelines," 2014. 
[2] David JA, et al, "Injected corticosteroids for treating plantar heel pain in adults (Review)," 2017. 
[3] Thomas JL, et al, "The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline - Revision 2010," 2010. 
[4] McMillan AM, et al, "Diagnostic imaging for chronic plantar heel pain: a systematic review and meta-analysis," 2009.

 

 

 

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