- Diff Dx:
-
distal tibial tarsal tunnel syndrome;
- expect tenderness superior to the origin of the plantar fascia (medial tubercle of os calcis);
-
plantar fascitis
- expect tenderness at the origin of the plantar fascia (medial tubercle of os calcis);
-
calcaneal apophysitis
- heel pain syndrome
- systemic syndromes:
- metabolic:
gout and
pseudogout;
- diabetes:
-
Paget's disease:
- inflammatory arthritides (
RA,
Reiter's Syndrome,
AS,
Psoriatic arthritis, ...)
- neoplastic: benign and malignant tumours:
- trauma:
- fat pad trauma: symptoms may last well over 6 months;
-
stress fracture (identified on 45 deg medial oblique view)
- acute fracture
- soft tissue contusion / repetitive trauma;
- puncture wound
- fat pad atrophy:
- heel pad has a specialized anatomy with small chambers of adipose tissue divided by fibrous septae,
but there are no documented changes in heel pain patients);
- Lab studies: (useful to r/o RA or Reiter's)
-
ESR;
-
RF;
-
Uric acid;
- X-rays:
- may demonstrate spurring of the medial calcaneal tuberosity;
- heel spurs are not in the
plantar fascia as is commonly thought but are found in the origin of the short flexors;
- they are present in 16% of normal population;
- Orthotics:
- with plantar heel tenderness consider a cushioned heel insert, to lessen the loading forces during
heel strike;
Chronic heel pain: Treatment rationale.
DE Baxter.
Orthop. Clin. North Am
Vol 20. 1989. p 563-569.
