When attempting to make a diagnosis of heel pain, there are a number of well-known differentials you should consider. These include apophysitis in children, fracture or trauma to the heel, and systemic illnesses such as rheumatoid arthritis, Reiter’s disease and ankylosing spondylitis.
The literature reports other causes as well. One that has recently gained more attention is nerve entrapment either within the tarsal canal or along the medial calcaneal branch of the medial plantar nerve. Consistent with this process is a triad of symptoms that have been reported together as well. These include posterior tibial tendon dysfunction and plantar fasciitis leading to a traction injury on the tibial nerve producing tarsal tunnel syndrome.
Whatever the cause of heel pain may be, starting off with a complete history and examination is essential in making the proper diagnosis. In addition, lab work and X-rays are often warranted in aiding the diagnostic process. The patient history often provides an abundance of information that you’ll need to sort through for important clues.
The shoes patients wear are often a key source of information. They say a lot about patients without you even asking a question. In fact, you can immediately obtain information as soon as you walk in the room with a quick glance at what they are wearing. Along this line are related questions about their footwear, what they most commonly wear and whether they go without shoes when they get the chance. Sometimes this may enable you to stumble over a simple change to their lifestyle that may aid in alleviating the heel pain.
Obviously, the easy patients are those who respond quickly to the initial line of therapy and advice. However, the more chronic the heel pain, the more thorough your examination needs to be. The patients with the chronic heel pain are the tough ones. They are the ones who take more time and energy to figure out. After all, the chronic heel pain patients have to overcome two things — the inflammation and the biomechanical etiology that caused the pain to occur.