Heel Pain: Causes, Diagnosis, and Treatment Options

Regarding heel pain?

Hello Dr.
Hsu,
I injured my ankle while playing basketball around the end of July last year.
After not fully recovering, I played again and landed awkwardly, putting all my weight on my heel.
At that moment, I felt a sudden sharp pain in my right heel.
I didn't think much of it at the time and assumed it was just a sprain.
However, after several months of persistent discomfort, I noticed that while walking, I didn't experience pain unless on uneven surfaces.

In November, after walking for an extended period, the pain became constant.
I have visited multiple hospitals without finding relief.
An orthopedic clinic took X-rays and confirmed that there were no bone issues, concluding that I have plantar fasciitis.
Although I understand that plantar fasciitis typically causes heel pain, I feel like the entire foot is affected.
It seems that the muscles and tendons in my right foot are looser than in my left, often making popping sounds, and I experience muscle twitching.
The orthopedic doctor mentioned that the first step in the morning is usually the most painful for plantar fasciitis, but I don't find that to be the case.
Instead, I feel pain even when my foot is resting on the ground shortly after getting up, and walking exacerbates the pain immediately.

I would like to ask if there could be other causes for my heel pain besides plantar fasciitis.
What could be the reason for the popping sounds and muscle twitching when I walk? Is it possible that I have bone spurs deep within the bone? What types of imaging can determine this? Additionally, what diagnostic tools can confirm plantar fasciitis?
Is surgery an option for this condition, and if so, what are the potential complications? I have been very distressed about my foot not improving, and I sincerely hope you can provide me with a detailed response.
Thank you very much.

Shun, 20~29 year old female. Ask Date: 2003/12/07

Dr. Xu Zhaoren reply Orthopedics

Based on the symptoms you described, it is likely "plantar fasciitis." The causes can be varied, including chronic or acute strains and other forms of arthritis.
Treatment methods include rest, wearing ergonomically designed shoes, and appropriate physical therapy.
Improvement is typically expected within three to six months.
If there is no improvement, local corticosteroid injections may be considered.
If symptoms still do not improve, surgical treatment may be contemplated.

Reply Date: 2003/12/07

More Info

Heel pain can be a frustrating and debilitating condition, especially when it persists despite various treatments. Based on your description, it seems that you have been dealing with heel pain for quite some time, stemming from an injury while playing basketball. This type of pain can arise from several underlying conditions, and understanding these can help guide you toward effective treatment options.

Common Causes of Heel Pain
1. Plantar Fasciitis: This is one of the most common causes of heel pain, especially if the pain is worse in the morning or after prolonged periods of inactivity. The plantar fascia is a thick band of tissue that runs across the bottom of your foot and connects your heel bone to your toes. Overuse, especially from activities like running or jumping, can lead to inflammation and pain.

2. Achilles Tendinitis: This condition involves inflammation of the Achilles tendon, which connects the calf muscles to the heel bone. It can cause pain at the back of the heel and is often exacerbated by activities that involve running or jumping.

3. Heel Spurs: These are bony growths that develop on the heel bone, often associated with plantar fasciitis. They can cause pain, especially when walking or standing.

4. Bursitis: Inflammation of the bursa (a small fluid-filled sac that reduces friction) at the heel can lead to pain and discomfort.

5. Tarsal Tunnel Syndrome: This condition occurs when the tibial nerve is compressed as it passes through the tarsal tunnel near the ankle, leading to pain that can radiate to the heel.

6. Stress Fractures: Repetitive stress or overuse can lead to small cracks in the heel bone, causing localized pain.

Diagnosis
To accurately diagnose the cause of your heel pain, a healthcare provider may recommend several diagnostic tests:
- X-rays: These can help rule out fractures or bone spurs.

- MRI: This imaging technique is useful for assessing soft tissue injuries, such as tears in the plantar fascia or Achilles tendon.

- Ultrasound: This can be used to visualize inflammation in the plantar fascia or Achilles tendon.

Treatment Options
1. Conservative Management: Most heel pain can be managed with conservative treatments, including:
- Rest: Avoid activities that exacerbate the pain.

- Ice Therapy: Applying ice to the heel can reduce inflammation.

- Stretching Exercises: Stretching the calf muscles and plantar fascia can alleviate tension.

- Orthotics: Custom or over-the-counter arch supports can help distribute pressure more evenly across the foot.

- Physical Therapy: A physical therapist can provide exercises and modalities to improve strength and flexibility.

2. Medications: Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can help reduce pain and inflammation.

3. Injections: Corticosteroid injections may be considered for persistent pain, particularly in cases of plantar fasciitis or Achilles tendinitis.

4. Surgery: If conservative treatments fail after several months, surgical options may be considered. This could involve releasing the plantar fascia or removing heel spurs. However, surgery carries risks, including infection and complications related to anesthesia.

Conclusion
Given your symptoms and the duration of your heel pain, it is essential to consult with a specialist, such as an orthopedic surgeon or a podiatrist, who can perform a thorough evaluation and recommend appropriate imaging studies. They can help determine whether your pain is indeed due to plantar fasciitis or if another condition is contributing to your discomfort.
In the meantime, consider modifying your activities to avoid aggravating your heel, and explore conservative treatment options. Remember that early intervention can often lead to better outcomes and a quicker return to your normal activities. If you have further questions or concerns, don't hesitate to reach out to a healthcare professional for personalized advice.

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