Tools to speed your heel pain diagnosis
Quickly zero in on a diagnosis by using our handy “photo guide” and reference table.
NSAIDs and neuromodulatory drugs (tricyclic antidepressants and antiseizure medications) have shown some success. Steroid injections have been effective when given at the site of entrapment,44 but care must be taken to avoid the posterior tibial tendon. If patients do not improve following these measures, they may require cast immobilization.45
Surgery is a possibility when other options fail. The cause of the neural compression is identified in 60% to 80% of cases.46,47 Success rates for various procedures of tarsal tunnel release and tibial nerve decompression range from 75% to 91%. If neural compression is absent, investigate other systemic causes of peripheral neuropathy, such as diabetes or alcoholism.4
Systemic diagnoses
Bilateral heel pain, multiple joint involvement, or fever suggests systemic disease. Common diseases affecting the heel include rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis, reactive arthritis, and inflammatory bowel disease.1 Successful treatment of these disorders should relieve associated heel pain.
Correspondence
H. E. Woodall, MD, AnMed Health Family Medicine Residency, 2000 E Greenville Street, Suite 3600, Anderson, SC 29621; hunter.woodall@anmedhealth.org
