Other causes of Heel pain

Foot & Ankle Conditions

1. Ankle Instability
2. Ankle Impingement
3. OCD of Talus
4. Foot Drop
5. Arthritis around Ankle


1. Insertional Achilles Tendinosis
2. Haglund's deformity
3. Planter Fasciitis
4. Other cause of heel pain


1. Flat foot/Pes planus
2. High Arched foot/Cavus foot/ Pes cavus
3. Mid foot Arthritis
4. Stress fracture
5. Planter fibromatosis
6. Deformity of Foot Arch
7. Accessory Navicular


1. Hallux valgus/Bunion
2. Hallux rigidus
3. Hallux varus
4. ingrowing toenail
5. Painfull sesamoids
6. Arthritis around Great Toe


1. Mallet toe
2. Hammer toe
3. Claw Toe
4. Bunionet


1. Complex deformities- cross over toe, Rheumatoid foot
2. Athlets feet
3. Corn's & Callosities
4. Morton's Neuroma
5. Metatersalgia


1. Non insertional Achilles Tendinosis
2. Achilles Tendon Injury / rupture
3. Tibialis Posterior Tendon Dysfunction
4. Flexor Hallucis tendon irritation
5. Peroneal Tendinopathy


1. Ankle Sprain
2. Ankle Fractures
3. Talus fracture
4. Calcaneum Fracture
5. Lisfranc's Injury
6. Midfoot fracture
7. fracture metatersal neck
8. Turf Toe injury

Other causes of Heel pain

Fat pad atrophy

Bottom of the heel is formed by a special type of fatty tissue layer between the thick sole skin and heel bone. This fat is elastic and helps absorbing shock and protects heel bone from impact of body weight during standing, walking, running and jumping. Due to this day to day impact fat pad suffer a and may get shrink and lost its elastic character and capacity to absorb impact. This is called fat pad atrophy.

Different factor can cause fat pad atrophy, like
  • Aging
  • Foot deformity and abnormal gait causing abnormal weight bearing on heel
  • Excess body weight causing excess wear and tear of fat pad
  • Planter fasciitis causing abnormal weight bearing on heel
  • Activities causing repeated impact on heel
  • Excess walking on hard surface
  • Inappropriate foot wear
  • Diseases like diabetes, lupus, rheumatoid arthritis can cause atrophy of fat pad
Pain at bottom of heel and difficulty in standing, walking, running like activity
If you feel pain at bottom of heel which is persisting and restricting your day to day activity you should visit a specialist foot & ankle surgeon.

Your doctor will examine your foot after analysing your symptom to find any predisposing factor like foot deformity, gait disturbance, faulty footwear and other cause of heel pain. He may ask you to get an x-ray of your foot both on standing and non-weightbearing, USG or MRI to establish the diagnosis and rule out any other cause of heel pain.

There is no cure of this condition. Treatment is directed to reduce symptom and make life comfortable. The recommendations are,
  • Rest
  • Soft shoe insert or heel cup
  • Orthopaedic shoe
  • Activity modification
  • NSAIDs and Icing

STONE BRUISE OR FAT PAD INFLAMMATION

Inflammation of fat pad due to acute injury or repeated impact injury causing inflammation of fat pad.

Any activity that causes injury to fat pad are responsible for stone bruise or fat pad inflammation.

Acute pain and difficulty in weight bearing.
Should visit a specialist foot and ankle surgeon on an emergency basis
After clinical evaluation he will ask for an x-ray to rule out any fracture; the first alternate diagnosis of acute severe heel pain
Rest, immobilization, icing, compression and NSAIDs are the mainstay of treatment

SEVERS DISEASE

Most common cause of heel pain in growing children adolescent. It happens due to injury of the calcaneum growth plate where Achilles tendon attached.

Due to repeated stress at epiphysis due to running, jumping and other activity. During growth spurt there are rapid changes happens within the cartilage which make them vulnerable to these activity related injure. Children participating in sports activity are more susceptible.

Pain and tenderness at back of heel which increases with activity.
If you have persistent pain at back of heel which aggravates with activity and restricts your activity.

It is a clinical diagnosis which your doctor will be confirmed from your history and examination. He may ask for a x-ray of heel to predict prognosis.

Rest, activity modification, icing, heel pad, shoe with raised heel, heel cord stretching and NSAIDs are the routine treatment of this condition. This is a self-limiting condition and resolves when growth spurts end.

BAXTER NERVE ENTRAPMENT SYNDROME

It is nerve entrapment syndrome due to entrapment of inferior calcaneum nerve also know as baxter nerve. It gives cutaneous sensory supply of heel and lateral sole and few foot muscles.

Inferior calcaneum nerve have a sharp bend and passes through a tight aponeurotic band at medial border of foot. The nerve can entrapped here and can produce the symptom

It causes symptom similar to planter fasciitis, pain at bottom of heel more on
If you feel pain at bottom of heel which is persisting and hampering your daily activity.

Clinically it is difficult to differentiate from planter fasciitis. It is suspected only when symptom of a suspected planter fasciitis does not respond with adequate treatment. Often planter flexion of little toe becomes week in nerve entrapment. Only a MRI can diagnose it from associated changes pathognomonic to the nerve entrapment. Planter fasciitis, nerve entrapment and heel pad atrophy can coexist.

Initial treatment is conservative with physical therapy and manipulation to reduce the tensile force of foot muscle and relive nerve entrapment. Orthotic and NSAIDs are recommended as adjunct.  Local infiltration with corticosteroid can help in reliving symptom. In non-responding cases with established diagnosis with MRI your doctor may advice for a nerve release surgery.

Planter fasciitis, insertional Achilles tendinosis, retrocalcaneal bursitis are the most common cause of heel pain but there are few more thing can manifest as heel pain. This pain can be felt either at bottom or back of heel. If heel pain is not due to above reasons then it might be due to

  • Fat pad atrophy
  • Stone Bruise or fat pad inflammation
  • Ankylosing spondylosis
  • Reactive arthritis
  • Stress fracture of calcaneum
  • Severs disease
  • Baxter nerve entrapment syndrome

ANKYLOSING SPONDYLOSIS

Ankylosing spondylosis is an inflammatory arthritis affects young male commonly. Axial skeleton involves primarily but it can cause heel pain at the attachment of Achilles tendon

REACTIVE ARTHRITIS

Similar like ankylosing spondylosis this is also an inflammatory arthritis affects axial as well as large synovial joints and can cause pain at attachment of Achilles tendon on heel bone.

STRESS FRACTURE OF CALCANEUM

Like other stress fracture of foot calcaneum can also have stress fracture especially in long-distance runner, army recruit or someone who starts sudden excessive activity.