Heel Pain



Background

  • 70% due to plantar fasciits (most spont. resolve)
  • Beware trauma (#), nocturnal pain, other joint pain or Hx malignancy

Clinical

Plantar fasciitis

  • Sharp pain under heel (± radiating to medial arch)
  • Worse first few steps in morning and late in evening
  • 1/3 bilateral
  • Risk factors: Obesity, Age >50, prolonged standing
  • Truigger point @ medial calcaneal tubercle
  • No Achilles or tibialis posterior (behind med malleolus) inflammation or crepitus

Differential Dx

  • Malignancy (unremitting pain, Hx malig., ↓weight, "B" symptoms)
  • Neurological (radiculopathy or tarsal tunnel) - neuro symptroms ± leg pain
  • Arthritis (other joints)

Investigations

  • Nil required (do not x-ray) if clinical plantar facsiitis

Management

  • Partially weight bear if possible for 6 weeks
  • Proper footwear (boring, laced shopws with proper heel)
  • Try NSAIDs (no strong evidence) ± PPI
  • Plantar fascia, achilles and calf stretch exercises
  • Provide an ADVICE SHEET of exercises etc


Content By Dr Íomhar O' Sullivan 30/06/2016. Last review Dr ÍOS 16/12/19.