Heel pain

Last evidence check April 2011

The plantar fascia is the principal soft tissue support of the longitudinal arch (Kitaoka 1992). Division of the fascia results in lowering of the arch, although this may not be clinically significant.

Degenerative changes are present in the plantar fascia of asymptomatic older people (Tountas and Fornasier 1996). Similar but more severe changes are seen in resected specimens at heel surgery (but as patients who come to surgery represent the most resistant group their histology may not be representative of the plantar fascitis population as a whole). Clinically apparent rupture is rare, but ultrasound and MR studies suggest partial tears may be reasonably common. Rupture may be precipitated by steroid injection. In patients with plantar fasciitis, ankle dorsiflexion is usually limited and calf power is reduced (Kibler et al 1991, Riddle et al 2003)

Baxter has emphasised compression of the nerve to quadratus plantae as a source of plantar heel pain. Rose et al (2003) found abnormalities of sensory testing in the medial calcaneal nerve distribution of three-quarters of patients with heel pain; half also had abnormalities in the medial plantar nerve distribution.

Labib et al (2002) described the “heel pain triad” of plantar fasciitis, posterior tibial tendonopathy and tarsal tunnel syndrome. They viewed it as a combined failure of the static (plantar fascia) and dynamic (tibialis posterior) supports of the arch.