Plantar heel pain refers to pain on the bottom of the foot. Heel pain is a common complaint, one that can become painfully disabling. The important structures of the plantar heel are the heel pad, calcaneus, or heel bone, the plantar fascia and the neuromuscular structures. Any or all of these structures can be the source of plantar heel pain.
Plantar Fasciitis
The plantar fascia is a fibrous structure on the bottom of the foot. After repetitive use or overload, the fascia may become injured, leading to pain. Plantar fasciitis is the most common cause of heel pain in adults. Dr. Tracy Aldridge of Southern University School of Medicine, writing in the journal American Family Physician, states that plantar fasciitis is most likely to be a noninflammatory degenerative process. The condition presents as morning pain or pain with prolonged standing. There are tender points over the calcaneus, or heel bone. The condition can be treated with anti-inflammatory medications, physical therapy, orthotics and steroid injections.
Atrophy of Heel Pad
Atrophy of the heel pad refers to a condition in which damage to the heel pad results in decreased size of the padding in the heel. This can occur after a steroid injection into the heel.
Bone Damage
Plantar heel pain can be caused by a calcaneus or heel bone fracture, tumor, infection or an enlarged bone spur. Osteomyelitis is an infection of the bone that can occur in the bones of the plantar foot leading to pain. Sever's disease is a reaction at the bone-tendon junction between the calcaneus and the Achilles tendon that can cause plantar heel pain in children. Sever's disease is also known as calcaneal apophysitis.
Nerve Damage
Neurologic causes of heel pain can come from compression of nerves in the foot and ankle, a neuroma on a peripheral nerve or referred pain from the spine. Tarsal tunnel syndrome is a condition where the posterior tibial nerve is compressed on the inside of the heel, leading to symptoms of heel pain. A neuroma is a growth or tumor of nerve tissue that cause pain. Degenerative disc disease of the spine can lead to a condition of referred pain that presents as heel pain.
Systemic Causes
The seronegative arthridites, which include psoriatic arthritis, Reiter's or reactive arthritis, ankylosing spondylitis and inflammatory bowel-related arthritis, can all be associated with ethesitis, or pain at a tendon-bone junction. Treatments for enthesitis are anti-inflammatory medications and physical therapy.
Skin Causes
Blisters and heel ulcers can also be a cause of plantar heel pain. Blisters can occur due to friction from a shoe. Heel ulcers are common in hospitalized patients and in diabetics with neuropathy.
References
- American Family Physician: Diagnosing Heel Pain in Adults
- "AAOS Comprehensive Orthopaedic Review"; Dr Jay Lieberman; 2008.
- "Sports Medicine Patient Advisor"; Dr. Pierre Rouzier; 2004.
