One of the most common ailments that brings patients in to my office is heel pain. Most frequently, the location is on the bottom of the heel, which can be related to inflammation of the plantar fascia, or, “plantar fasciitis”. However, not all heel pain is plantar fasciitis, and this is where a good examination and work-up by a physician is key.
For instance, pain on the back of the heel can be related to your Achilles tendon where it inserts on the heel bone, or, “calcaneus”. There may or may not be an associated bone spur. Treatment for this type of heel pain is different, often relying more on immobilization in a walking boot, physical therapy, and sometimes surgery to address the problem. It is not the same as plantar fasciitis and the treatment must be specific.
Pain on the medial, or inside, part of the heel which is sharp, burning, or radiating can be related to a nerve irritation or entrapment such as Tarsal Tunnel Syndrome or Baxter’s neuritis. Again, treatment can be very different than for traditional heel pain, and these nerve conditions may not respond to anti-inflammatories or orthotics the way plantar fasciitis does.
Lateral, or outside, heel pain can also be related to a nerve problem but may involve the peroneal tendons as they travel around the tip of the outside ankle bone, or lateral malleolus. The peroneal tendons are important in preventing your ankle and back of foot from rolling out and supinating too much, so those with a higher-arched foot type are more prone to this issue.
The take-home message is that if your heel pain is not responding to initial remedies such as rest and more support in your shoes, see your podiatrist. Not all heel pain is plantar fasciitis, and not all plantar fasciitis goes away without a little professional help!
