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Uncovering the Causes of Heel Pain: A Practical Guide to Differential Diagnosis

Differential Diagnosis – Heel Pain

Does your heel feel tender and sore when you wake up in the morning? Do you experience a recurring ache during activities that linger for days? Have you noticed any new, painful bumps on the back of your heel lately? Your heels might simply be tired or there may possibly be another source behind your discomfort. It’s time to investigate what is causing this bothersome pain.

Pain in the feet is an ordinary occurrence, but if it persists or worsens over time, you should investigate further. All heel pain shares one same trait: It’s a sign that your heels need healing and attention. Don’t ignore this warning; it might be telling you something much greater than just discomfort!

Establishing and Assessing the Relevance of Patient Histories

To identify the potential source of heel pain, it’s critical to take a thorough patient history.

For how long has the patient experienced this issue? How often does the pain come and continue? What alleviates or exacerbates it further? Has any treatment been tried before and were they effective in reducing symptoms? Could there have been accompanying trauma that led to this discomfort, plus is there a history of heel pain among his family members as well as systemic arthritic conditions present too?

After obtaining all the necessary information, certain aspects should be taken into account. To start, evaluate for how long the pain has been present – if it is acute in nature then more common causes such as a stress fracture or gout are likely culprits; however, nerve irritation could also be an underlying cause albeit less commonly so.

When assessing the duration of the pain, ask yourself how long it lasts. If it is short-lived and improves after movement, consider plantar fasciitis, systemic arthritic heel pain, or subtle nerve entrapment as possibilities. On the other hand, if your discomfort continues for a prolonged period or worsens with activity then look into possible causes such as nerve entrapment, fracture, cyst, or even a potentially torn plantar calcaneal tendon.

Finally, trauma and family history are very helpful. Traumatic causes of heel pain include fracture, tendon tear, or fascia tear. If there is a family history of systemic ­­arthritic conditions, this can be very useful information in the diagnostic workup.

Common causes of heel pain

Heel pain can be caused by a variety of factors, such as overstressing the heel with long-distance running or structural issues affecting the bones and soft tissues. To name a few key culprits behind this uncomfortable condition, here are some of the most common causes:

1. Plantar fasciitis

Plantar fasciitis is the most common source of heel pain. This dense ligament runs from the heel bone to the toes, and when excessively pulled, its fibers become inflamed which can cause discomfort. Typically this ache is registered at where it attaches to the heel; yet in some scenarios, one may feel a throbbing throughout their foot too.

People aged 40-70 who lead an active lifestyle and those with occupations that involve extended periods of standing are at the highest risk for developing this condition, particularly runners.

Pregnant women and those who struggle with excess weight are particularly vulnerable to plantar fasciitis, as the extra poundage adds strain on the ligament. Fortunately, however, there are several ways to reduce your chances of developing this condition by taking proactive steps such as wearing supportive shoes and stretching regularly.

Moreover, inadequate arch support in shoes and structural foot problems like flat feet or high arches can result in plantar fasciitis.

causes of heel pain


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2. Heel bursitis

This painful condition is caused by the inflammation of a bursa, which is a fibrous sac filled with fluid that cushions our heel’s bones, ligaments, and muscles. This can come from landing hard on your heels too frequently or simply wearing shoes that put excessive pressure on your foot.

As the day progresses, you will begin to feel a deep ache in either your heel or back. Furthermore, swelling of the Achilles tendon is also not uncommon. This pain may reach an unbearable level if left untreated.


Related: 9 Best Home Remedies for Heel Pain and Plantar Fasciitis

3. Heel spurs

These mineral deposits can elicit an unnatural bony protrusion on the underside of the heel which is caused by stretching and exertion of muscles, and ligaments, as well as damage to the heel bone membrane. Heel spurs are common amongst athletes who take part in running and jumping sports.


4. Achilles tendinitis

The Achilles tendon is a vital piece of anatomy that links your calf muscles to the heel bone, assisting in activities like walking, running, jumping, or pushing off your toes. Unfortunately, when we overuse this tissue – typically as runners who push beyond their limits – can develop an injury known as Achilles tendinitis.

Prolonged overextension of the Achilles tendon causes it to develop minuscule rips and tears, ultimately leading to a thickened, weakened tendon which is accompanied by excruciating pain located at the heel. Additionally, you may experience restricted movement as your foot flexes.


Related: The Best Option for Heel Pain Treatment

5. Heel fracture

The calcaneus, the large bone of your heel, can be fractured in two ways: suddenly due to an unexpected event or slowly over time from excessive usage. Regardless of how it occurs, a fracture on this part of your body can result in significant discomfort.

Calcaneus fracture following a traumatic event – If you experience sudden, acute pain in your heel following a heavy fall, jump from a height, or car accident – chances are that it is fractured. To diagnose this condition and determine the best treatment plan – the doctor will take X-rays as well as conduct physical examinations of their patients. Based on the severity of the fracture they can then decide which type of healing procedure to follow.

Heel fracture resulting from overuse – Stress fractures often start as a thin, barely visible crack on the bone surface which can lead to pain that builds up gradually over time.

Experiencing a stress fracture can bring forth varying symptoms depending on where the break is located and how serious it may be. You might find that walking causes you considerable heel pain, yet this discomfort could still persist even when inactive. Very often, morning time will bear less painful sensations while evening hours tend to make the condition worse.

If you are concerned that a stress fracture may have occurred in your heel, it is important to take action right away. Try not to place too much weight on the affected area and make an appointment with a podiatrist as soon as possible. Without proper medical treatment, the pain can reach unbearable levels and may even result in a full-blown fracture of the bone!


Related: Heel Spur: Cause, Symptoms, Treatment, and How to Avoid It


In conclusion, heel pain can be caused by a variety of conditions and should not be ignored. Heel pain is often the result of overuse or injury to one of several different structures in the foot, including the bursa, Achilles tendon, plantar fascia, and calcaneus bones. It’s important to seek medical advice to identify the cause of heel pain and determine the most appropriate treatment plan. With early diagnosis, timely treatment, and ample rest, most cases of heel pain can be successfully managed and prevented from reoccurring.

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