Heel pain
Heel pain is a regional pain syndrome dominated by plantar fasciitis, diagnosed clinically by its first-step morning pattern and tender medial calcaneal tubercle, with stretching, NSAIDs, and a corticosteroid injection ladder as first-line treatment.
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What this article covers
- Overview
A regional pain syndrome, not a single disease: heel pain is produced by a small set of distinct hindfoot conditions distinguished chiefly by exact location and timing of pain; plantar fasciitis is…
- Epidemiology
Plantar fasciitis dominates: it is the most common cause of self-limited heel and foot pain in adults.
- Risk factors
Obesity: the leading modifiable risk factor for plantar fasciitis.
- Pathophysiology
Plantar fasciitis is chronic microtear and degeneration, not pure inflammation: repetitive overuse or stress on the plantar fascia causes microtears and recurrent inflammation at its origin on the…
- Clinical features
Plantar fasciitis (hallmark, establishes the diagnosis): sharp, medial-inferior heel pain that is classically worst with the first steps in the morning or after any period of inactivity, improves…
- Differential diagnosis
Achilles tendinopathy: posterior (not plantar) heel pain worse with activity, tender 2-6 cm above the calcaneal insertion, unlike the medial-inferior plantar tenderness of plantar fasciitis.
- Diagnosis
Heel pain is primarily a clinical diagnosis: plantar fasciitis, Achilles tendinopathy, and tarsal tunnel syndrome are each diagnosed by their characteristic location, timing, and provocative sign…
- Management
First, for plantar fasciitis (the default pathway), start conservative measures: calf and plantar fascia stretching, ice after activity, and avoiding flat/unsupportive shoes, plus arch supports if pes planus is present.
- Complications
Chronic or refractory pain: persistence beyond the expected course despite conservative therapy is the most common complication of plantar fasciitis.
- Prognosis
Plantar fasciitis is generally self-limited but slow to resolve: resolution can take many months even with adherence to stretching, though most improve without surgery.
- Prevention
Weight management: reducing obesity, the leading modifiable risk factor, lowers plantar fascia loading.
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