CAUSES OF HEEL PAIN
1) Plantar fasciitis: The most common cause of heel pain; an inflammatory condition of the plantar fascia, the ligament responsible for supporting the foot.
2) Calcaneal apophysitis: Pain and inflammation of the growth plate present in the heel bone in adolescents.
3) Calcaneal spur: This generally refers to an area of calcification found in the plantar fascia and is rarely a cause of heel pain. A "spur" may also be found, at times, at the area in which the Achilles tendon attached to the back of the heel.
4) Nerve entrapment: various nerves found in the foot can become damaged or compressed causing heel pain.
a) Tarsal tunnel syndrome: The major nerve to the bottom of the foot passes through a tunnel at the inside of the ankle. Entrapment of the posterior tibial nerve can cause pain on the entire plantar (bottom) surface of the foot and may not be related to physical activity.
b) Medial calcaneal nerve entrapment: Nerve on the inside of the heel causing burning pain on the inside of the heel.
c) Baxter's nerve entrapment (inferior calcaneal nerve): Probably the most common nerve entrapment confused with plantar fasciitis as the inferior calcaneal nerve runs along the bottom of the heel near the origin of the plantar fascia.
d) Medial plantar nerve entrapment: The branch of the posterior tibial nerve that runs along the inside of the bottom of the foot, may cause shooting pains and numbness to the bottom of the big toe.
e) Lateral plantar nerve entrapment: The branch of the posterior tibial nerve that runs along the outside of the bottom of the foot.
5) Achilles tendinitis: Inflammation of the tendon that attaches to the back of the heel bone.
6) Plantar fasciosis: Fasciosis refers to a degenerative process of the plantar fascia. Once termed "intractable plantar fasciitis" as it does not respond to treatments for plantar fasciitis.
7) Achilles tendinosis
8) AICT (achilles insertional calcific tendinopathy)
9) Calcaneal stress fracture
10) Rheumatoid arthritis
11) Reiter's syndrome
12) Ankylosing spondylitis
13) Heel fat pad atrophy
14) Periostitis
15) Referred pain (pathology elsewhere in the body resulting in heel pain)
16) Lumbosacral disc disease, especially L5, S1
17) Infection of the heel bone (calcaneus)
18) Arterial insufficiency
19) Biomechanical strain
20) Myositis
21) Calcaneal bursitis
This is not mean to be an all inclusive list as there are other causes of heel pain. Plantar fasciitis is the most common cause but, if persistent or if not responding to treatment, a more thorough workup is needed.
