Current Concepts on the Management of Heel Pain

, Georgetown University Medical Center, Washington, DC.

In This Article

Abstract and Introduction


Heel pain syndrome is a chronic degenerative/reparative process secondary to stress overload. Patients describe a gradual increase in plantar heel pain over weeks to months. Pain is characteristically associated with weight bearing, especially in the morning, or when rising from a chair. Physical examination will typically reveal localized tenderness over the medial process of the tuberosity, localized swelling, and a tight thickened plantar fascia. Ancillary testing may include plain radiographs, bone scan, or MRI; electromyogram for suspected nerve etiologies; and blood work for rheumatologic causes. For the majority of patients the most successful treatment method is nonoperative. It consists of a combination of activity modification and a stretching program. Initial management could include plantar fascial night splints, visco-elastic heel cups and non-steroidal anti-inflammatory drugs (NSAIDs). For recalcitrant cases, taping, corticosteroid injections and casting of the foot may be necessary. Surgical intervention should be reserved for those cases where conservative measures have failed for a minimum of 6, and preferably 12, months.


Heel pain, one of the most common complaints involving the hind foot, may arise from posterior or plantar etiologies. Heel pain syndrome (plantar fasciitis, heel spur, etc.) is a frequent cause for plantar heel pain and a therapeutic challenge. This article will review the pertinent anatomy, etiology, examination, differential diagnosis, and conservative and operative management for treatment of heel pain syndrome.


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