Plantar Heel Pain

Wikis > Orthopaedics > Plantar Heel Pain

See: Plantar fasciitis

See also:
Piezogenic papules:
Small papules due to herniation of subcutaneous fat that appear on weightbearing around heel. Piezogenic papules are common, but are an uncommon cause of heel pain. Treat with heel cups.

Calcaneal stress fracture:
Diffuse pain over plantar surface. May be seen on lateral x-ray 3 to 4 weeks post onset of symptoms. Treat with 6-8weeks modified rest. Casting if not responding.

Sever’s disease/calcaneal apophysitis:

Nerve entrapment:
Commonly missed cause of heel pain is entrapment of first branch of lateral plantar nerve – has been suggested to be cause of up to 20% of all heel pains. Tenderness is greatest over course of nerve, especially over medial border of quadratus plantae muscle

Referred Pain:
Entrapment of S1 at the spinal level can refer pain to the distribution of the medial plantar nerve.

Plantar fibromatosis/Ledderhose Disease:
Local proliferation of fibrous tissue in the plantar fascia  painful thick nodules in plantar fascia (0.5-3cm). Pathologically similar to Dupuytren’s disease in the hand. May be painful.
Treatment – if small  leave. May be able to achieve pain reduction if treated similar to plantar fasciitis. Up to 60% recur with surgery unless remove adjacent fascia removed.

Os peroneum syndrome:
Plantar lateral midfoot/rearfoot pain – could vary from fracture of os peroneum or irritation of sesamoid.

Metastatic Tumour:
Heel pain has been reported as the initial presenting feature in cases of metastatic breast carcinoma and a case of metastatic prostate cancer

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