Heel pain is one of the most common complaints that brings patients to a podiatry office. For the majority of patients, heel pain will be due to tissue changes within the plantar fascia, the connective tissue that supports the arch of the foot. This condition is known as plantar fasciopathy, or plantar fasciitis. However, for many patients, heel pain might be an early warning sign of peripheral neuropathy.
If plantar fasciopathy is the source of your heel pain, this is easily seen with diagnostic ultrasound. The properly trained doctor can measure the changes within the tissue and recommend a course of treatment based on these findings. If your doctor has not examined your foot with ultrasound, you may not have received an accurate diagnosis.
Few doctors have been trained to look for nerve complications as a possible source or contributing factor of heel pain. Yet the nerves on the inside of the heel and back of the ankle may be contributing to the pain or may even be the sole source of the pain. In a 2003 study, it was found that 72% of patients with heel pain had a co-existing neural involvement. The consequences of doctors not looking for possible nerve entrapments include the potential for suboptimal treatment and the possibility of missing a diagnosis on the source of the heel pain.
The nerves most commonly involved in heel pain are the medial calcaneal nerve and the nerves associated with tarsal tunnel syndrome, which include the lateral plantar, medial plantar and posterior tibial nerves. Due to the location of these nerves, the pain signal may relate as coming from the heel. A simple diagnostic block of those nerves, performed in office, can help the physician determine the degree of involvement and alter the treatment to best address all sources of pain.
Signs that your Heel Pain may have a Neural Origin:
- Pain is worse after rest or first thing in the morning.
- Pain has a burning nature.
- Pain continues at night when you are off your feet.
- Pain gets worse throughout the day.
- Orthotics increase pain.
In some cases, the diagnosis of a medial calcaneal nerve entrapment or tarsal tunnel syndrome was the first indication of the onset of Type II diabetes.
At US Neuropathy Centers, our physicians are well trained in the latest diagnostic principles. We understand the importance of a throughout and accurate diagnosis to ensure you receive the best possible treatment. Contact any one of our specialists today!
The advice and information contained in this article is for educational purposes only, and is not intended to replace or counter a physician’s advice or judgment. Please always consult your physician before taking any advice learned here or in any other educational medical material.
@US Neuropathy Centers, 2018
Rose JD, Malay DS, Sorrento DL: Neurosensory testing of the medial calcaneal and medial plantar nerves in patients with plantar heel pain. J Foot Ankle Surg 2003, 42(4):173-177.