Symptoms and Diagnosis of Heel Pain

 

talk to patient about heel pain

 

Doctors and podiatrists generally agree that most heel pain is caused by an underlying case of plantar fasciitis; it is actually the inflammation of the plantar fascia that causes heel pain and not anything that may be happening directly in the heel.

This in no way means that plantar fasciitis is the only cause of heel pain, however. There are other serious issues such as arthritis, stress fractures, sciatica, tarsal tunnel syndrome, and abnormal movement in the feet, all of which your specialist may take into consideration depending on your symptoms. Diagnosing heel pain can be tricky because more than one symptom can be present at a time. Also, one condition (such as plantar fasciitis), may be the cause of another condition (such as heel spurs).

This is why diagnosis and treatment can require a lot of patience; much of the recovery process depends on trial and error. Fortunately for most suffers the treatments for a variety of heel pain are the same, so even if the diagnosis is not precise it’s likely that the proscribed treatment will have a positive effect on pain reduction. In fact, it quite often happens that the issue gets resolved without an absolutely precise diagnosis.

Common Symptoms:

One very common symptom of heel pain is that it’s usually at its peak first thing in the morning when sufferers first get out of bed and begin moving around, though the discomfort often lasts for the remainder of the day and may flare up again after much walking or standing.

When this occurs it almost always indicates a case of plantar fasciitis and possibly heel spurs. Heel pain can also cause feet to be sensitive to touch, although the source of discomfort may appear to ‘move around’ the surface of the foot, which often causes confusion.

Simple Tests

Simple tests refer to non-invasive test that are performed when a clearer diagnose of the source of heel pain is needed. Here are the most common simple tests you are likely to encounter:

Tape Test: When properly applied, athletic tape can provide immense relief for plantar fasciitis, so if taping the foot works to reduce pain levels then plantar fasciitis is the most likely diagnosis of heel pain.

Firm Heel Pad and Calf Test:  If stretching out the calf muscles or the use of a firm heel orthotic under the heel immediately reduces pain then tightness of the calf muscles is the most likely source of discomfort. A lack of flexibility in the calf muscles places excessive stress on the plantar fascia, causing inflammation and foot and heel pain.

Soft Heel Pad Test: If a soft heel pad immediately reduces discomfort you may have plantar fasciitis but a stress fracture or insufficient heel pad tissue levels could also be the underlying issue and your doctor will have to further examine you.

Your doctor may also perform the following tests to check for plantar fasciitis:

  • Ask you to purposely increase pressure on your  toes while you are walking,
  • Ask you to point your feet toward each other while you are walking.
  • Have you walk on the outside of your feet.
  • Have you compress the afflicted area with the palm of the hand.

If any of these activities positively affect your pain symptoms then it increases the chances of plantar fasciitis being the underlying source of your heel pain. If anti-flammatories effectively reduce foot and heel pain this is also an indicator that plantar fasciitis is the source of pain.

Advanced Tests

Advanced tests refer to more invasive tests that must be performed at a hospital. Here are the most common advanced tests used to diagnose the underlying source of heel pain:

Bone Scans:  Bone scans are not the same as an x-ray; this type of exam  uses special injections in the vein and a special camera to scan the bones looking for blood pooling, or ‘hot spots’, in the foot. Technicians can expect to find elevated blood flow where the fascia connects to the heel, and the more blood found usually indicates more pain is being experienced by the patient.

Bone scans will also pick up small stress fractures, internal infections of the foot, or surgical wounds. A ‘negative’ bone scan usually means that stress fractures get ruled out as a source of pain and the specialist will then focus on other potential underlying issues such as nerve damage or arthritis.

Plantar fasciitis will not usually be considered at this point as the doctor will likely have ruled it out if there is no early morning pain or if none of the simple tests indicate its presence.

Nerve Tests: These are potentially uncomfortable tests that neurologists use to track the nerve path that your pain is following; it can indicate if it is a nerve issue that is causing heel pain through nervous system transference.

Blood Tests: If your doctor suspects’ arthritis is the source of your discomfort you will most likely undergo a blood test; there are specific markers that will allow your doctor to diagnose if it is arthritis, but blood tests cannot rule out arthritis. If there is arthritis present in other parts of the body this would support an inflammatory disease diagnosis.

Ultrasounds: Ultrasounds are used to look an increased thickness in the plantar fascia; studies have shown that the plantar fascia is twice as thick in people suffering from heel pain as it is in people who were not experiencing discomfort. Thick tissue usually indicates long-term inflammation and irritation of the plantar fascia.

Patient History and Lifestyle: A patient’s history and lifestyle, while not a test, is one of the most revealing diagnostic tools that your doctor can use. When an obese woman who is 37 years of age suddenly increases the amount of physical activity in her life after living a sedentary lifestyle for several years and she begins to experience heel pain, well, her doctor is not going to perform advance testing; her doctor is going to assume it’s inflammation of the plantar fascia and treat her accordingly.

And this rule doesn’t just apply to middle-age people with weight issue; when heel pain occurs simultaneously with increased activity or sudden or notable weight gain then plantar fasciitis (heel spurs) is going to be the assumed cause unless there are other significant symptoms indicating that this is not the most likely cause.

Thin heel pads and plantar fasciitis are two of the most causes of heel pain and your doctor will most likely evaluate you along these lines unless there are symptoms—or lack thereof—to indicate otherwise.

Conclusion

Medically speaking there are many conditions that can cause heel pain, but practically speaking, plantar fasciitis is still the most common underlying condition. Because heel pain can be difficult to diagnose it’s always best to talk to your doctor if your discomfort is chronic or severe.

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