Heel pain is a prevalent complaint in outpatient settings, with mechanical issues being the most frequent underlying cause. Pinpointing the location of the discomfort is crucial for accurate diagnosis. Plantar fasciitis is the most common culprit, typically causing pain in the medial plantar heel, especially upon taking the first steps after waking or following periods of inactivity.
Other sources of plantar heel pain include calcaneal stress fractures, which present as progressively worsening pain linked to increased activity or harder surfaces. Nerve entrapment should be considered when pain is accompanied by burning, tingling, or numbness. Heel pad syndrome manifests as a deep, bruise-like pain in the central heel. Neuromas and plantar warts are also potential causes.
Pain at the back of the heel, or posterior heel pain, is often associated with Achilles tendinopathy. Tendinopathies in general can cause pain at the point where the tendon inserts into the bone. Haglund deformity, a bony prominence on the calcaneus, can also lead to posterior heel pain due to bursa inflammation between the calcaneus and the Achilles tendon. In children, Sever disease, or calcaneal apophysitis, is another cause of posterior heel pain.
Medial midfoot heel pain, particularly when it worsens with continued weight-bearing, may indicate tarsal tunnel syndrome. This condition arises from the compression of the posterior tibial nerve as it passes through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus.
Lateral midfoot heel pain can be a symptom of sinus tarsi syndrome. This syndrome affects the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints.
A thorough patient history and physical examination are essential for distinguishing between the various causes of calcaneal pain. Imaging studies may be necessary to confirm the diagnosis in some cases.
