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Diagnosis of heel pain.

Publication ,  Journal Article
Tu, P; Bytomski, JR
Published in: Am Fam Physician
October 15, 2011

Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.

Duke Scholars

Published In

Am Fam Physician

EISSN

1532-0650

Publication Date

October 15, 2011

Volume

84

Issue

8

Start / End Page

909 / 916

Location

United States

Related Subject Headings

  • Tendinopathy
  • Tarsal Tunnel Syndrome
  • Pain
  • Humans
  • Heel Spur
  • Heel
  • General & Internal Medicine
  • Fractures, Stress
  • Foot Diseases
  • Fasciitis, Plantar
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Tu, P., & Bytomski, J. R. (2011). Diagnosis of heel pain. Am Fam Physician, 84(8), 909–916.
Tu, Priscilla, and Jeffrey R. Bytomski. “Diagnosis of heel pain.Am Fam Physician 84, no. 8 (October 15, 2011): 909–16.
Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011 Oct 15;84(8):909–16.
Tu, Priscilla, and Jeffrey R. Bytomski. “Diagnosis of heel pain.Am Fam Physician, vol. 84, no. 8, Oct. 2011, pp. 909–16.
Tu P, Bytomski JR. Diagnosis of heel pain. Am Fam Physician. 2011 Oct 15;84(8):909–916.

Published In

Am Fam Physician

EISSN

1532-0650

Publication Date

October 15, 2011

Volume

84

Issue

8

Start / End Page

909 / 916

Location

United States

Related Subject Headings

  • Tendinopathy
  • Tarsal Tunnel Syndrome
  • Pain
  • Humans
  • Heel Spur
  • Heel
  • General & Internal Medicine
  • Fractures, Stress
  • Foot Diseases
  • Fasciitis, Plantar