1. Heel Pain and You
Causes and Treatment for a
Common Foe

2. What is Heel Pain?
• The human foot is
largely a triangle
• The plantar fascia is
the base of the triangle
• This supports the arch
• Can be pulled, strained
and injured with
activity
Plantar fascia

3. What is Heel Pain?
• With increased load on the
foot, the fascia is stretched
and inflamed
• Once inflamed, every step
injures it over and over again

4. Causes of Heel Pain
• Overuse
syndromes
– Carrying heavy
loads while walking
– Increased body
weight
– Overstretching
activities

5. Causes of Heel Pain
• Trauma
– Fall from a height
• Frank fracture
– Constant and repetitive load on the feet
• Stress fracture
– Weight falling on the foot

6. Causes of Heel Pain
• Infection
– Direct extension
• Stepping on sharp object
– Hematologic spread
• Distal infection travels
through the blood

7. Causes of Heel Pain
• Biomechanics
– Flatfoot condition
– Tight Achilles tendons
– Bunion deformities
– Painful areas causing
alteration of gait
– Inappropriate shoes

8. Causes of Heel Pain
• Arthritides
– Rheumatoid arthritis
– Ankylosing spondylitis (Marie-Strumpel)
– Gout
– Psoriatic arthritis
– Systemic lupus erythematosis
– Reiter’s syndrome
– Enteropathic arthritides (Irritable bowel syndrome)

9. Causes of Heel Pain
• Entrapment of nerves in the spine
(radiculopathy)
• Lesion at the DRG (dorsal root ganglion)
• Lesion at the peripheral nerve or terminal branch
• Test by NCS (nerve conduction studies), EMG
(electromyographic studies), F wave and H reflex
studies or magnetic resonance imaging

10. Causes of Heel Pain
• Tumors of bone are a
rare but serious
cause of heel pain
• Pain in the heel or
fracture through the
tumor may be the
first sign

11. Treatment of Heel Pain
• Non-steroidal anti-inflammatory medications
• Steroidal anti-inflammatory injections
• Orthotics
• Proper shoes
• Stretching exercises (?)
• Physical therapy

12. Treatment of Heel Pain
(when conservative measures fail)
• ESWT
• Surgery
• Tarsal tunnel
release

13. Tarsal Tunnel Release
• Entrapment of the
Posterior tibialis nerve
with medial calcaneal
branch to the heel
• Release is like a carpal
tunnel procedure, but
for the ankle

14. Achilles Tendinosis Pain
• Due to strain of the Achilles
tendon
– Possibly short Achilles
• If chronic, may cause a bone
spur (Haglund’s deformity)
– Never inject steroids near this
– Except for heel lifts and open-back
shoes, very little conservative
treatment for this
– Surgical correction of the bump
and the short Achilles is best

15. Heel Pain (conclusions)
• If you work on your feet, wearing decent shoes can help avoid
significant problems.
• Once the pain presents itself, 99% of Plantar fasciitis problems
can be dealt with via conservative means (Non-steroidal anti-
inflammatory therapy and Steroidal anti-inflammatory
injections) and orthotic support in the shoes
• If conservative measures fail, ruling out a spinal entrapment,
Tarsal tunnel syndrome or arthritides must be done before any
consideration of ESWT or surgery

16. Thank You