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

Links

• EMed.ie Plantar Fasciitis advice sheet
• Arthritis Research UK. Exercises to manage foot pain. www.arthritisresearchuk.org/arthritis-information/conditions/foot-pain/foot-pain-exercises.aspx