clinical features

Last reviewed 01/2018

History may be of a pain that is initially migratory or diffuse. With time the pain localises to the area of the medial calcaneal tuberosity. The pain is usually of gradual onset and is worst on first weight bearing in the morning. The heel pain generally decreases during the day but may worsen with increased activity e.g. jogging. A pain that worsens during the day is more typical of calcaneal stress fractures or nerve entrapment. A nocturnal heel pain may be due to infections, tumours and neuropathic pain e.g. tarsal tunnel syndrome.

The examination of the muscles and joints of the foot is normal.

A tender point is localised to the insertion of the plantar fascia into the inner part of the calcaneum (anteromedial aspect of the heel). If the tenderness is in the centre of the posterior part of the heel then this may be due to other causes of inferior heel pain such as bruising or atrophy of the heel pad or to subcalcaneal bursitis. If there is tenderness on mediolateral compression of the heel then this may be due to a stress fracture of the calcaneum. A diagnosis of tarsal tunnel syndrome or entrapment of the nerve to abductor digiti minimi would be suggested if heel pain was produced from percussion on the medial aspect of the heel.