HEEL PAIN

San Antonio Podiatrist, Dr. Ed Davis, discusses systemic causes of heel pain.

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Causes of heel pain are numerous.  Plantar fasciitis is the most common cause but heel pain that is persistent may have a number of other sources.

Dr. Ed Davis believes that the most important step in the treatment of heel pain is obtaining an accurate diagnosis.

Heel pain is often self diagnosed and treated. The web and advertising media filled with claims of cures.
There are numerous health related chat boards online where stories of treatments are shared.  Treatments which appear to work for one person do not work for the next.  Attempting numerous treatments without knowing exactly what is being treated can often prolong the course to effective relief.

Systemic causes of heel pain
Systemic causes of heel pain are those causes of heel pain which do not originate in the foot, generally conditions which may affect the entire body.  Some common conditions which can cause heel pain include:

1) Rheumatoid arthritis
2) Gout
3) Reiters syndrome
4) Ankylosing spondylitis
5) Psoriatic arthritis
6) Inflammatory bowel disease
7) Paget's disease
8) Osteoid osteoma
9) Sarcoidosis
10) Infections
11) Metastatic disease
12) Sickle cell disease

Rheumatoid arthritis
Rheumatoid arthritis is a chronic inflammatory disorder that attacks joints but may also affect other tissues.  It mainly affects synovial tissue which is the lining of the joints or joint capsule, the tissue surrounding the joint. It affects women three times more often than men. It is an autoimmune disease, that is, a disease in which the body develops an immune response against its own tissue.  See: http://www.arthritis.org/rheumatoid-arthritis.php

This disease process can affect tissues other than joints, that is, extra-ariticular manifestations. Heel pain caused by rheumatoid arthritis can occur early in the disease process, before there is joint pain.  Such heel pain is not mechanical in nature like plantar fasciitis so the level of physical activity may not affect  this.  Rheumatoid arthritis may cause "morning stiffness" so this may be similar or confused with the "first step" pain encountered with plantar fasciitis.

The diagnosis of rheumatoid arthritis may be assisted by lab tests.  The traditional lab test for RA is known as rheumatoid factor (RF).  A positive rheumatoid factor is present in about 75 to 80% of patients with rheumatoid arthritis but can also be found in some patients with chronic bacterial infections as well as some viral infections and parasitic diseases.   A newer test is the anti-CCP antibody (anticyclic citrullinated peptide antibody) and is more specific than the RF.

The reasons why rheumatoid arthritis can cause heel pain are not understood. X-rays may show bone erosions.  A more recent study performed via diagnostic ultrasound revealed the possibility of rupture of the membranes (septae) which hold the heel pad together underneath the heel bone.  There is a thick cushion of fat tissue under the heel bone held together by fibrous cells or septae.  Diagnostic ultrasound or sonography has become the "gold standard" for the examination of heel pain.



Gout

Gout an inflammatory joint disease caused by high levels of uric acid in the body. Uric acid is a "waste" product due to the breakdown of DNA and RNA and is normally excreted by the kidneys.  High uric acid levels can occur to the failure of the kidneys to excrete sufficient amounts of uric acid or by overproduction of uric acid by the body.  It is often seen acutely as swollen joints, often the big toe joint.  Chronic gout due to untreated high uric acid levels (hyperuricemia) can create areas of chronic inflammation due to deposits of uric acid with the heel being one of the more common areas.