Diagnosis of calcaneal stress fracture must be eliminated when evaluating chronic heel pain. A bone scan may be necessary if radiographs do not show changes characteristic of fracture. Pain posterior to the medial malleolus with radiation to the medial heel may be caused by compression of the posterior tibial nerve as it passes behind the medial malleolus with the flexor digitorum longus and blood vessel. Longitudinal traction from repetitive overuse can irritate the nerve. Signs and symptoms of tarsal tunnel syndrome are Tinel's sign, a positive nerve conduction study, and pain along the nerve course.
Further treatment includes injection of corticosteroids into the tunnel.
Finally, surgical decompression of the tunnel is warranted if the above remedies fail. Curbside Consults brings the consultant to you. Send us your question. If its answer would be of value and interest to our audience of primary care physicians, you may see it in an upcoming issue. The McGraw-Hill Companies.