The patient has focal heel tenderness, and there is radiographic evidence of a heel spur. Heel pain usually is a result of overuse and often is chronic. The differential diagnosis includes plantar fasciitis, compression of the nerve to the abductor digiti quinti, calcaneal bursitis or stress fracture, compression of the posterior tibial nerve, and tarsal tunnel syndrome. Plantar fasciitis, a common cause of heel pain, is insidious in onset and causes weight-bearing pain after rest. Pain may subside after the patient takes a few steps, but it sometimes becomes persistent.
Tenderness usually is localized to the calcaneal attachment of the plantar fascia.
It often is associated with pes planus or excessive flexibility in the forefoot that results in repeated stretching of the fascia origin at the calcaneus. Plantar fascial pain typically is relieved with heel cups or pads. Orthotics that decrease pronation and support the longitudinal arch relieve symptoms by easing tension in the fascia. Passive stretching of the heel cord and longitudinal arch is useful, as are night splints that immobilize the ankle at 90 degrees and extend the toes. Local corticosteroid injection may be needed if other treatments are unsuccessful.