Monday, November 10, 2014
CAUSES OF HEEL PAIN
Here are some other conditions that can generate foot pain symptoms very similar to those of Plantar Fasciitis, and sometimes these conditions can be mistaken for Plantar Fasciitis.
- Nerve Entrapment – Entrapment of the first branch of the lateral plantar nerve, can cause heel pain. The entrapment usually occurs between the abductor hallucis muscle and the quadratus plantae muscle, giving patients a burning sensation on the plantar aspect of the heel that is aggravated by daily activities and may even persist at rest. Palpation of this area may prove painful, with a tingling sensation. The same conservative modalities that are used to treat plantar fasciitis are effective in treating this condition.
Nerve entrapment can also be caused by enlargement of the plantar fascia itself. A healthy plantar fascia normally is only 3mm-3.8mm thick. It is not uncommon to see patients with chronic plantar fasciitis where the ligament has thickened beyond 7mm. In such cases the thickened plantar facia can displace other tissue onto the nerves in the heel thereby causing heel pain.
- Rupture of the Plantar Fascia – Rupture of the plantar fascia is an uncommon cause of plantar heel pain. Patients often report severe pain in the arch of the foot following a physical trauma, patients can often recall a snapping sensation felt within the foot at the time of injury.
Physical examination may reveal a palpable lump in the plantar fascia. Patients also experience severe pain on palpation of the plantar fascia. Treatment generally consists of some kind of immobilisation for several weeks followed by a stretching program.
- Calcaneal Fracture – Acute heel pain caused by calcaneal fracture. Such heel pain can closely resemble the symptoms usually associated with plantar fasciitis. Fracture can be caused by a recent abrupt increase in daily exercise or other activities or from a impact injury sustained when landing after a fall or jump. Patients with this condition often report increased pain when the heel bone is squeezed along it’s outer aspects rather than from palpating the plantar (underneath) aspect of the heel.
- Sciatica – Heel pain can occur when there is increased pressure on the L5-S1 nerve root in the lumbar spine, this nerve provides segmental innervation to the posterior thigh, and the gluteal, anterior, posterior and lateral leg muscles, as well as sensation to the heel. Patients with sciatica often report sharp pain radiating down the buttocks and the posterior aspect of the thigh and leg and even into the heel.
- Radiculopathy – A term used to describe a problem with nerves where the problem is at or near the root of the nerve in the spine but symptoms are often felt further away at the other end of the nerve through a process called referred pain. For example, a nerve root impingement in the neck can produce pain and weakness in the forearm. Likewise, an impingement in the lower back or lumbar-sacral spine can be manifested with symptoms in the foot. Often when radiculopathy is present a simple test known as a straight leg raise will reproduce neuroma like symptoms in the foot. If you have a history of back pain you should ask your clinician to consider radiculopathy as a potential cause of your foot pain.
- Tarsal Tunnel Syndrome – One of the main nerves of the foot can become compressed as it passes through a anatomical tunnel in the ankle. In such cases patients can experience symptoms similar to plantar fasciitis, such as burning and tingling in the heel or forefoot. A simple clinical test called the Tinel’s test can be used to evaluate for tarsal tunnel syndrome. The test involves tapping the tibial nerve below the ankle, a positive test produces tingling in the forefoot.
- Systemic Causes – Rarely heel pain can be caused by a separate underlying medical condition, such causes are described as being systemic. They include:
Inflammatory conditions, including rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, Reiter’s syndrome, gout, Behçet’s syndrome and systemic lupus erythematosus. Most patients with systemic disease experience joint pain and inflammation in other areas of the body, but symptoms may occasionally begin in the heel. When heel pain is of systemic origin, treatment should, of course, be directed toward the underlying disease.
- Sever’s Disease – Sever’s disease usually affects boys between six and 10 years of age, often affecting those who are extremely active. In most cases, the pain is located in the posterior aspect of the calcaneus and is more severe after sporting activity. Palpation of the posterior aspect of the calcaneus around the insertion of the Achilles tendon usually reveals local tenderness. Patients with this disorder may have a tight Achilles tendon with limited ankle dorsiflexion, which sometimes causes patients to walk on their toes to decrease the pain. The treatment is generally simple and involves modifying activity levels, stretching, icing and orthotics.