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. If pain persists beyond a year despite conservative treatment, surgical release of the medial half of the plantar fascia may be warranted. Compression of the nerve to the abductor digiti quinti where it courses deep to the plantar fascia may cause chronic heel pain. Compression at this location causes pain at the same point as plantar fasciitis.
Treatment is surgical decompression of the nerve.
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.