Here at Dr. Bob, we field a lot of questions about heel pain! Heel pain is one of the most common complaints among podiatric patients. But, the cause of the pain isn’t always easy to identify.
About 7 times in 10, the prime culprit is plantar fasciitis. Plantar fasciitis is the inflammation of the plantar fascia – the tissue which connects the heel to the ball of the foot.
When the plantar fascia becomes overstretched, dozens of tiny tears develop and irritate the tissue. While at rest, the tissue heals and tightens. The result? That characteristic pain and stiffness in the heel first thing in the morning. The pain usually subsides within a few minutes of bearing weight, as the fascia has a chance to stretch out.
But what about those times when it’s NOT plantar fasciitis? If your pain isn’t responding to treatment, our doctors can provide a second opinion! Check out what our experts had to say about some of the more obscure sources of heel pain.
“Every possibility must be considered.”
With such a high diagnosis rate, it’s easy to slap the plantar fasciitis label on every case of heel pain that hobbles into the clinic. However, misdiagnosing heel pain can delay healing and can even cause more problems.
When you visit your foot and ankle specialist, he or she will rule out possible conditions through testing and examination. But if their list of working diagnoses is incomplete, it will be that much more difficult to zero in on the true cause.
Dr. Bob Baravarian explained, “Heel pain could stem from many causes: nerve pain, bursitis, stress fracture, bone bruise, or bone cyst. When you’re dealing with a mechanism as complex as the human foot, every possibility must be considered.”
Nerve Pain
Nerve pain can often feel much like plantar fasciitis, except the pain often gets worse with extended periods of walking or standing. Nerve pain can also feel more like tingling or burning and can migrate to the lower back.
Nerve conditions that cause pain in the heel come in two main flavors: Baxter’s neuritis and tarsal tunnel syndrome.
- Baxter’s Neuritis: Associated with a small nerve branch that runs from the inside of the heel to the bottom of the heel.
- Tarsal Tunnel Syndrome: Associated with nerve compression on the side of the ankle. Comparable to carpal tunnel syndrome in the wrist.
“To distinguish between the two, we would apply pressure or tap on certain points of the foot, and note any pain or tingling sensations that result,” said Dr. Baravarian. “Another thing we can do is administer a numbing agent to pinpoint the particular nerve that’s causing the problem.” If the pain dissipates, you’ve got your answer.
Bursitis
A bursa is a thin, fluid-filled sac that cushions soft tissue from friction against a bone. Heel bursitis develops when one of these bursae, located on the bottom of the heel, becomes inflamed. Unlike plantar fasciitis, bursitis pain gets worse with increased walking, as extended pressure irritates the tissue.
Your foot and ankle specialist can diagnose bursitis using an ultrasound. The imaging will show an inflamed bursa alongside a normal plantar fascia.
Getting the right diagnosis is crucial to healing because while many treatments for heel pain involve sturdy custom orthotics, bursitis actually requires soft cushioning to reduce pressure.
Heel Stress Fractures
Heel stress fractures are born from trauma and are usually associated with at least one other injury. Stress fractures can develop gradually – say, while spending too much time in a bad pair of shoes – or they can result from an acute injury – such as a long fall with a hard landing.
Your foot and ankle specialist can usually identify a stress fracture with a squeeze of the sides of the heel (psst – it will hurt!) and an advanced imaging test, such as an X-ray or MRI.
To treat a stress fracture, your foot will be placed in a boot or a cast to allow it 4-6 weeks of rest.
Heel Bone Bruise
A bone bruise on the heel bone also results from trauma, but there’s no fracture: just inflammation of the bone and bruising. An X-ray can’t pick up on a bone bruise, but an MRI can offer clues. Bone bruises hurt and can hinder your daily activities, but there isn’t much to be done except to rest and let it heal itself.
In rare cases, the inflammation goes deep into the internal bone structure, making it difficult for the bruise to resolve on its own. Your foot and ankle specialist can inject the bone with donor material to reduce inflammation and promote healing.
Heel Bone Cyst
Heel bone cysts are the rarest cause of heel pain, but they can and do occur. An internal tumor or bone cyst can weaken the heel bone, causing swelling and pain, especially when in motion and bearing weight. Furthermore, the weakened bone is more susceptible to stress fractures, which can greatly increase the pain.
Your foot and ankle specialist can diagnose a bone cyst using an X-ray. A follow-up CT scan or MRI may be needed for confirmation. Typically, a surgeon would perform an excision to remove the cyst, or at least administer a biopsy to rule out any possibility of malignancy (cancer).
Why Choose Dr. Bob Baravarian For Your Foot Care?
If you’re experiencing heel pain and your symptoms aren’t getting better with treatment, schedule an appointment with the physicians at Dr. Bob. Incorrect treatment can only exacerbate your injury and prolong your pain. An accurate diagnosis is key to a speedy and complete recovery. A nationally recognized foot and ankle specialist, he provides the most advanced podiatric care with some of the highest success rates in the nation. Dr. Bob is a leader in researching, diagnosing, and treating all foot and ankle conditions.
To schedule a consultation, please call (855) 557-5400 or make an appointment now.
Dr. Bob Baravarian is conveniently located in Los Angeles, near Cedars-Sinai Medical Center, providing expert foot and ankle care for patients throughout Southern California.
