Heel Pain

Aka: Heel Pain, Hindfoot Pain

1. Causes: Entrapment Neuropathy
   1. Consider Lumbar Radiculopathy (L4-S2)
   2. Paresthesias of plantar surface, walking and at night
      1. Tarsal Tunnel Syndrome
   3. Burning pain at heel pad
      1. Abductor digiti quinti nerve entrapment
   4. Medial and plantar Heel Pain
      1. Medial calcaneal branch of posterior tibial nerve
2. Causes: Inflammatory conditions with bilateral involvement
   1. Ankylosing Spondylitis
   2. Psoriatic Arthritis
   3. Reactive Arthritis
   4. Reiter's Syndrome
   5. Rheumatoid Arthritis
   6. Gouty Arthritis
   7. Systemic Lupus Erythematosus (SLE)
3. Causes: Infectious Disease
   1. Diabetic Foot Ulcer
   2. Osteomyelitis
   3. Plantar Wart
4. Causes: Skeletal Conditions
   1. Calcaneal Stress Fracture
   2. Paget's Disease
   3. Bony Tumor (e.g. Ewing Sarcoma)
   4. Calcaneal Apophysitis (Sever's Disease) in Adolescent
   5. Os Trigonum Syndrome
5. Causes: Soft Tissue Conditions
   1. Fat pad syndrome (fat pad atrophy)
   2. Plantar fascia rupture
   3. Black Dot Heel
   4. Heel Bruise
   5. Plantar Fasciitis
   6. Retroachilles bursitis (Pump-Bump)
   7. Retrocalcaneal Bursitis
   8. Flexor Hallucis Longus Tendonitis
6. Causes: Heel Pain by location
   1. Midfoot pain
      1. Lateral pain
         1. Peroneus longus or peroneus brevis Tendonitis
      2. Medial pain
         1. Flexor digitorum or hallucis longus Tendonitis
         2. Tibialis posterior Tendonitis
   2. Posterior plantar Foot Pain
      1. Plantar Fasciitis
      2. Plantar fascia rupture
      3. Heel pad dysfunction
         1. Heel pad atrophy: Elderly or obese patients
         2. Heel pad inflammation: Athletes
      4. Tarsal Tunnel Syndrome
      5. Calcaneal neuroma (rare)
      6. Bone cyst
      7. Calcaneal Osteomyelitis (from contiguous Cellulitis)
      8. Calcaneal Stress Fracture
      9. Ewing's Sarcoma of Calcaneus
   3. Posterior Heel Pain
      1. Achilles Tendonitis
      2. Retroachilles bursitis (Pump-Bump)
      3. Retrocalcaneal Bursitis
7. References
   1. Aldridge (2004) Am Fam Physician 70:332-8
   2. Barrett (1999) Am Fam Physician 59(8):2200-6
   3. Madden (1996) Am Fam Physician 54(6):1995-2000
   4. Van Wyngarden (1997) Am Fam Physician 2207-12
   5. Tu (2011) Am Fam Physician 84(8):909-16