Symptoms and Diagnosis of Heel Pain



It is generally accepted by doctors and podiatrists that most heel pain is preceded and/or directly causes by the development of plantar fasciitis, which is an inflammation of the plantar fascia that causes discomfort throughout the entire foot, including the heel and surrounding area.

Your specialist, however, will consider that heel pain can also be caused by many other conditions as well, such as stress fractures, arthritis, nerve damage, tarsal tunnel syndrome, and abnormal foot formation or movement. These conditions do not always occur independently of one another and there may be more than one issue causing heel pain; in fact, one condition may be causing another condition to occur (as is often seen with plantar fasciitis and heel spurs.)

Fortunately, when it comes to heel pain similar treatments are often used for a variety of issues and patients often experience relief without ever having precise knowledge of the exact cause of their pain.

Common Symptoms, Heel Pain:

Most patients who suffer from heel pain report that their discomfort is most intense upon waking in the morning when they get out of bed and take their first few steps. While there could other reasons for this pain the most common cause is plantar fasciitis (heel spurs). Unfortunately, most patients also report that the pain lasts throughout the day and is simply most intense when walking or standing. Many sufferers have also noticed tenderness in the foot when it is being touched or rubbed, particularly in the heel though the pain can ‘move around’ to different areas of the foot.

Simple Tests

There are a few simple tests that can be performed to better diagnose the nature of the foot pain being experienced:

Tape Test: There are several techniques of applying tape to the body to alleviate pressure points and pain, and if taping methods used in the feet reduce pain symptoms then it’s likely that tension in the plantar fascia is the source of discomfort.

Firm Heel Pad and Calf Test:  If the introduction of a firm supportive heel pad or one inch of smoothly folded paper under the heel, or if stretching the calf muscles brings immediate relief of pain symptoms then lack of flexibility in the calf muscles is the underlying issue. Tight calf muscles place excessive stress on the plantar fascia, which in turn causes pain in the foot and heel.

Soft Heel Pad Test: If it is the introduction of a soft heel pad that relieves pain symptoms it may be plantar fasciitis, but it might also indicate the presence of a stress fracture or insufficient tissue levels (and therefore cushioning) under the heels.

The following test may help pinpoint whether or not plantar fascia is the underlying source of pain:

  • Put pressure on the toes while walking,
  • Point your foot toward the other foot while walking (point it inward).
  • Walk on the outer edges of the feet.
  • Compress the affected area with the palm of your hand.

If these tests reduce paint symptoms then it is likely that plantar fasciitis is the cause of the discomfort. This is also true if anti-inflammatories have a positive impact on pain reduction.

Advanced Tests

There are times when simple tests are not sufficient in providing an accurate diagnosis and more medically advanced tests are needed to pinpoint the source of foot pain.

Bone Scans:  This type of examination often shows an increase in blood flow at the point where the fascia attaches to the heel, especially in cases where the pain is classed as severe.

It seems likely that small stress fractures can occur due from repetitive pulling on a heel spur by the fascia, and a bone scan can not only detect this type of injury it can also detect infection, or surgical wounds. When bone scans come back negative stress fractures are generally ruled out and other causes of pain, such as nerve function or plantar fasciitis, move to the forefront.

If a bone scan is positive, there are no signs of infection, and a specific incidence of injury occurred then it is likely a stress fracture and proper treatment, such as the use of a cast, is undertaken. Early morning pain is not usually a symptom that occurs with a stress fracture or nerve compression, and a lack of this symptom may be enough to warrant a bone scan.

Nerve Tests: This is a mildly painful procedure that neurologists use to help rule out nerve problems as a cause of heel pain. Nerve conduction velocity tests are also performed to see if pain is transferring to the foot by way of a connecting nerve path.

Blood Tests: Blood tests are most often applied when arthritis is the suspected cause of pain, and while these tests can confirm that there are markers of an inflammatory disease they can only prove that arthritis is present, not that it isn’t present.

Ultrasounds: An ultrasound study can help to detect whether or not there is an increased thickness in the plantar fascia. One study that used an ultrasound to examine the foot found that the fascia was twice as thick in heel pain patients as it was in people without heel pain, which makes the results fairly reliable.

Patient History and Lifestyle: One of the most revealing diagnostic tools is not a test at all, but rather an observation of the patient’s history and lifestyle. For instance, if an overweight, 35 year old woman has increased her level of physical activity after years of being sedentary and is now experiencing heel pain, doctors are unlikely to perform advanced testing; they’re likely going to deduce that it’s plantar fasciitis and provide the appropriate treatments.

When heel pain begins at the same time as a change or increase in activity, or after significant weight gain then it‘s generally assumed to be plantar fasciitis (heel spurs) unless there are other important symptoms present.

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