Why is my heel pain not getting better?

What is plantar heel pain?

Plantar heel pain is an umbrella term consisting of several pain sources around the heel. Most commonly plantar fasciitis however, this condition may be over-diagnosed. So for today’s post I thought I would shed some light on some other causes or potential co-existing conditions that may be hinder your recovery.

What are the symptoms of plantar fasciitis?

This will often has a gradual onset and is pronounced with your first steps in the morning. It is presented with localized pain at the location under the inner heel and is aggravated with increased bouts of activity like barefoot walking, prolonged standing and running. Additionally, it is rare for shooting, pins & needles, burning or numbness to be present.

What else could it be?

If this doesn’t describe your particular symptoms, then there may be other structures influencing your symptoms. Let’s discuss other common sources:

1. Nerve entrapment: This usually has more spreading, radiating symptoms including pins and needles.
2. Stress fracture: Some common sites include the heel & other bones of the arch. When stress fractures become severe they often present with night pain, background pain and sometimes swelling.
3. Bursitis: You have several bursa around your foot which present with obvious swelling.
4. Fat-pad atrophy: Common in older runners.
5. S1 nerve radiculopathy: Pain referral from the back. Commonly accompanied with low back pain or back stiffness.

Plantar heel pain can be chronic and extremely frustrating. Understanding what structures are impacting recovery does require a skilled health professional so be wary if your symptoms do not resolve over a short period of time. If you are experiencing ongoing symptoms with no relief, consider a change in treatment or a second opinion.

Relevant Blog posts

• 5 ways to overcome plantar fasciitis
• Do I need strong feet for running?
• The dangers when buying new running shoes

Relevant Podcast episodes

• Strength training 5: Keep your feet strong with Tim Bransdon
• Plantar Fasciitis 1: Causes, diagnosis & characteristics
• Plantar Fasciitis 2: Rehabilitation & prevention

References

• Alshami et al. A review of plantar heel pain of neural origin: Differential diagnosis and management (2008).