From the Guidelines
Heel pain is most commonly caused by repetitive load and stress on the heel, leading to conditions such as stress fractures of the calcaneus, plantar fasciitis, and soft tissue trauma like acute rupture of the plantar fascia 1.
Common Causes of Heel Pain
- Traumatic heel pain can occur due to acute trauma to the calcaneus, often caused by a fall onto the heel from height, resulting in intra-articular fractures involving the subtalar joint 1
- Neurologic heel pain can occur due to irritation or entrapment of one or more nerves innervating the heel, or more proximal nerve impingement syndromes 1
- Other causes of heel pain include tumors, infections, and vascular compromise, although these are rare 1
Diagnostic Considerations
When diagnosing heel pain, radiographs and bone scans may be negative, and MRI and high-frequency US are commonly used imaging modalities 1. In cases where neurologic heel pain is suspected, subspecialist referral for evaluation and diagnostic testing, including electromyography and nerve conduction velocity studies, may be necessary 1
From the Research
Causes of Heel Pain
Heel pain can be caused by a variety of factors, including:
- Mechanical etiology, which is the most common cause 2, 3, 4
- Plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest 2, 3, 4, 5
- Calcaneal stress fracture, which can cause progressively worsening pain following an increase in activity level or change to a harder walking surface 2, 3, 4
- Nerve entrapment or neuroma, which can cause pain accompanied by burning, tingling, or numbness 2, 3, 4
- Heel pad syndrome, which can cause deep, bruise-like pain in the middle of the heel 2, 3, 4
- Achilles tendinopathy, which can cause posterior heel pain 2, 3, 4
- Haglund deformity, which can cause posterior heel pain due to a prominence of the calcaneus that may lead to retrocalcaneal bursa inflammation 2, 3
- Sever disease, which is a calcaneal apophysitis common in children and adolescents that can cause posterior heel pain 2, 3
- Tarsal tunnel syndrome, which can cause medial midfoot heel pain, particularly with prolonged weight bearing, due to compression of the posterior tibial nerve 2, 3, 4
- Sinus tarsi syndrome, which can cause lateral midfoot heel pain and a feeling of instability, particularly with increased activity or walking on uneven surfaces 2, 3
- Infectious causes, such as osteomyelitis or septic arthritis, which can cause heel pain 6
Location of Heel Pain
The location of heel pain can be a guide to the proper diagnosis, with:
- Medial plantar heel pain often caused by plantar fasciitis 2, 3, 4, 5
- Posterior heel pain often caused by Achilles tendinopathy, Haglund deformity, or Sever disease 2, 3, 4
- Lateral midfoot heel pain often caused by sinus tarsi syndrome 2, 3
- Medial midfoot heel pain often caused by tarsal tunnel syndrome 2, 3, 4