Inferior heel pain

Abstract

Inferior heel pain affects up to 10% of the population. There are multiple pathologies and these can be considered by the anatomical structure affected (i.e. bone, nerve, ligamentous and other soft tissues). The most common pathology is in ligamentous and soft tissue. The plantar fascia may be degenerate (fasciosis), torn or enthesopathic, or there may be peri-fascial oedema. Soft tissue conditions include heel pad bruising and atrophy and tumours. Neurological causes are probably the next most common and include tarsal tunnel syndrome, nerve to abductor digiti quinti neuropathy, medial calcaneal neuropathy and lumbo-sacral radiculopathy. Bony pathologies include calcaneal stress fracture, calcaneal bone marrow oedema, tumours and osteomyelitis. The presenting features of each of these conditions are discussed, followed by the treatment options. The multitude of modalities used to treat plantar fascia-related pain are discussed in greater detail. The management of inferior heel pain involves a careful history and clinical examination. Not all heel pain is simply related to the plantar fascia. Without considering the other potential sources of pathology for which treatments may be markedly different, the clinician may easily unwittingly discount these. It is therefore incumbent to be clinically prudent, having a logical approach to assessment and diagnosis, prior to embarking on an appropriate course of treatment.