The document discusses heel pain, its causes, and treatment options. Heel pain is often caused by overuse or trauma to the plantar fascia, which supports the foot's arch. Common causes include overuse from carrying heavy loads, increased body weight, repetitive stress, or trauma from falls or fractures. Treatment begins with conservative options like rest, stretching, orthotics, and anti-inflammatory drugs. If conservative treatments fail, further evaluation is needed to rule out conditions like tarsal tunnel syndrome before more invasive options such as shockwave therapy or surgery are considered.

1. Heel Pain and You
Causes and Treatment for a
Common Foe

2. What is Heel Pain?
• The human foot is
largely a triangle
• The plantar fascia is
the base of the triangle
• This supports the arch
• Can be pulled, strained
and injured with
activity
Plantar fascia

3. What is Heel Pain?
• With increased load on the
foot, the fascia is stretched
and inflamed
• Once inflamed, every step
injures it over and over again

4. Causes of Heel Pain
• Overuse
syndromes
– Carrying heavy
loads while walking
– Increased body
weight
– Overstretching
activities

5. Causes of Heel Pain
• Trauma
– Fall from a height
• Frank fracture
– Constant and repetitive load on the feet
• Stress fracture
– Weight falling on the foot

6. Causes of Heel Pain
• Infection
– Direct extension
• Stepping on sharp object
– Hematologic spread
• Distal infection travels
through the blood

7. Causes of Heel Pain
• Biomechanics
– Flatfoot condition
– Tight Achilles tendons
– Bunion deformities
– Painful areas causing
alteration of gait
– Inappropriate shoes

8. Causes of Heel Pain
• Arthritides
– Rheumatoid arthritis
– Ankylosing spondylitis (Marie-Strumpel)
– Gout
– Psoriatic arthritis
– Systemic lupus erythematosis
– Reiter’s syndrome
– Enteropathic arthritides (Irritable bowel syndrome)

9. Causes of Heel Pain
• Entrapment of nerves in the spine
(radiculopathy)
• Lesion at the DRG (dorsal root ganglion)
• Lesion at the peripheral nerve or terminal branch
• Test by NCS (nerve conduction studies), EMG
(electromyographic studies), F wave and H reflex
studies or magnetic resonance imaging

10. Causes of Heel Pain
• Tumors of bone are a
rare but serious
cause of heel pain
• Pain in the heel or
fracture through the
tumor may be the
first sign

11. Treatment of Heel Pain
• Non-steroidal anti-inflammatory medications
• Steroidal anti-inflammatory injections
• Orthotics
• Proper shoes
• Stretching exercises (?)
• Physical therapy

12. Treatment of Heel Pain
(when conservative measures fail)
• ESWT
• Surgery
• Tarsal tunnel
release

13. Tarsal Tunnel Release
• Entrapment of the
Posterior tibialis nerve
with medial calcaneal
branch to the heel
• Release is like a carpal
tunnel procedure, but
for the ankle

14. Achilles Tendinosis Pain
• Due to strain of the Achilles
tendon
– Possibly short Achilles
• If chronic, may cause a bone
spur (Haglund’s deformity)
– Never inject steroids near this
– Except for heel lifts and open-back
shoes, very little conservative
treatment for this
– Surgical correction of the bump
and the short Achilles is best

15. Heel Pain (conclusions)
• If you work on your feet, wearing decent shoes can help avoid
significant problems.
• Once the pain presents itself, 99% of Plantar fasciitis problems
can be dealt with via conservative means (Non-steroidal anti-
inflammatory therapy and Steroidal anti-inflammatory
injections) and orthotic support in the shoes
• If conservative measures fail, ruling out a spinal entrapment,
Tarsal tunnel syndrome or arthritides must be done before any
consideration of ESWT or surgery

16. Thank You