One of the most common patient complaints to a foot and ankle physician is heel pain. It is important for patients to understand there are many other causes of heel pain and we will review some of those today. A short list of these would include lumbosacral radiculopathy, plantar fascial rupture, tarsal tunnel syndrome, Baxter’s nerve entrapment and fat pad atrophy.
Lumbosacral radiculopathy:
The most common cause of back pain leading to heel pain is nerve entrapment around L4-S1 vertebral level. Most patients will have a history of back pain or heel pain that manifests. It is important to consider an MRI of back for this or any EMG NCV which are nerve conduction studies. Often times physical therapy for nerve medication can help control the symptoms.
Plantar fascial rupture:
Ruptures of the plantar fascia are relatively uncommon, but can occur for patients that have had ongoing heel pain. The majority of patients that we see rupture their fascia have had some sort of high impact activity like football players or long distance runners. Diagnosis of the rupture often includes an MRI treatment can depend on the varying degree of the rupture in the site of the rupture. There many options for plantar fascial rupture including repair.
Tarsal tunnel syndrome:
Tarsal tunnel syndrome is a nerve entrapment that is similar to carpal tunnel. Usually involves the posterior tibial nerve and branches that wrap around the heel. Many patients will describe burning or tingling in predispositions, this include patients with diabetes or a flatfoot. Often times an MRI or nerve conduction study is needed to verify this. Treatment often can require steroid injections or decompression of the nerve.
Baxter’s nerve entrapment:
This is a common condition that a lot of physicians will not recognize as this is a tough diagnosis. This can be undiagnosed or underdiagnosed relatively easily. This often times can be confused a tarsal tunnel syndrome as well. One of the key diagnostic indicators for this is inability to move your fifth digit. Again often times advanced imaging is utilized and a steroid injection and sometimes decompression the nerve is required.
Fat pad atrophy:
Fat pad atrophy is typically seen in older or obese patients. The majority us have a nice cushion on the bottom of the heel to help with shock and provide support. Often times there are thinning in other areas of the foot that can be identified help clue physicians in. This usually can be solid with a prescription orthotic and a rocker-bottom soft tissue.
If you have heel pain, call Issaquah Foot and Ankle Specialists today at 425-391-8666 or make an appointment online.
