Heel pain can be extremely debilitating but, for most of my patients, I can help them successfully resolve it with proper diagnosis and conservative measures. To do so, nothing is more important than making sure I get a proper history and perform a complete and thorough patient examination to diagnose heel pain, actually all foot pain, for that matter.
Although plantar fascilitis is the most common reason patients may come to me with heel pain, there are a variety of other possible causes, including but not limited to:
- A plantar fascia or flexor tear
- tarsal tunnel syndrome
- Baxter’s nerve entrapment
- calcaneal stress fracture or cyst
- arthritis
- gout
It is very important that we consider the full range of possible causes before reaching a diagnosis. Where Google may be helpful for patients in providing some basic information or even confirmation of why their heel hurts, it is not a substitute for my extensive training and years of diagnostic work. So, when dealing with heel pain, it’s important to consider every possibility. And, the only way to get at that is with a thorough history and diagnostic testing.
Getting a thorough history
The diagnostic history needs to include…
- Is it a recent injury?
- Is that heel pain emanating from a secondary or structural problem in the foot?
- How often does the pain occur?
- How long does the pain last?
- What makes the problem worse?
- What gives the patient relief from the pain?
- Have they tried other treatments and, if so, how successful have they been?
- Is there a family history of heel pain?
- Is there a systemic arthritic condition?
Based on the answers to these questions, it often triggers more extensive questions I ask patients about their heel pain to help identify the source of the problem and determine the appropriate tests to run.
Conducting diagnostic testing
The next step is to run the relevant diagnostic tests. This may involve some—but not necessarily all—of the following:
- Physical exam
- standard foot/ankle radiographs (X-rays)
- diagnostic ultrasound
- magnetic resonance imaging (MRI)
- computed tomography (CT)
- nerve conduction velocity testing (NCV)
- three-phase bone scan
- electromyelogram testing (EMG)
- neurosensory testing
What’s next
With a thorough workup and proper diagnostic testing, I am able to systematically analyze heel pain and diagnose it. The next step is to provide each patient with an appropriate treatment plan customized to the specific diagnosis.
Have heel pain and need relief?
We are here for all your foot care needs. You may come and see me by scheduling an appointment at 305-229-9595.