Heel Pain: Maybe Not What You Think

By breid

Originally printed for the online version of the South County Independent
Posted: Thursday, September 11, 2014 8:15 am | Updated: 10:20 am, Thu Sep 11, 2014.
Smart Fitness: Rebuilding You – Common heel pain may be more than it seems By Bert Reid DPT Sometimes things are not what they seem. The most common type of foot pain is heel pain, and it occurs most often to the active population over age 40.
Many people report the symptoms of severe, sharp pain in the pad of the heel upon rising from bed or a prolonged sit (“post-static pain”). Very often, the pain starts after a new activity or an increased intensity for a familiar workout. Occasionally there is “insidious” pain onset, meaning no one is sure when it started or why.
Plantar fasciitis is a very common form of heel pain. There is another form that is completely different called Baxter’s Nerve Impingement. It mimics the symptoms of plantar fasciitis exactly, except for one characteristic. Let’s examine both:
Plantar fasciitis: This heel pain at the rear pad of the foot occurs while walking or running. The symptoms are often their worst in the morning, and may last for months. Most patients complain of pain with the “first few steps.” Your doctor may test the area by sticking the point of their thumb into the heel pad. This, combined with the history of the pain, may lead to a diagnosis of plantar fasciitis, or inflammatory arch pain. It is important to note there is a normal tension on the arch. We need to keep normal tension while walking, within range, to keep the foot arch happy. There may be a heel spur contributing, but research also shows heel spurs with no symptoms in up to 61 percent of feet. Steroid injections to confront the inflammation are successful in about 70 percent of patients though there may be as many as 10 percent where the plantar fasica ruptures as a result of the injection.
Baxter’s Nerve Impingement: This presents itself with exactly the same symptoms as plantar fasciitis, but there also is a marked severe pain at the inside of the heel bone along a path up toward the inside ankle bone – the path of the lateral calcaneal nerve. It accounts for as much as 20 percent of all heel pain. The difference here is that the side-of-heel pain is not present in plantar fasciitis. Doctors can inject the area to differentiate between the two. If it is Baxter’s, you’ll know within 10 seconds. The release of this nerve compression requires surgery in most cases.
Orthoses (shoe inserts often called orthotics) have been shown to be effective in many trials for plantar fasciitis, Achilles pain and for patellofemoral pain (aka knee pain). Essentially, a good pliable foot orthotic helps re-lock (or re-supinate) the foot upon push off. This reduces added stress to the arch. In an overpronatory rearfoot, there also is increased stress to the arch. Your physician or physical therapist can help diagnose and treat this.
Either way, remember not to treat the symptoms that occur, but rather tackle the reason the added arch stress occurs. Most often in overpronatory rearfoot, it is the biomechanics of too much stress to the arch, but in Baxter’s it is a structural problem.
Each month OPT Physical Therapist’s Team of P.T.’s will contribute a column related to Fitness and Sports Injuries. This month was written by Bert Reid, D.P.T. Bert is the co-owner of OPT Physical Therapy and Foot Orthotics, which has an office in Wakefield. He has advanced training in foot orthotic fabrication, foot biomechanics and running science. He also has advanced training in Rotator Cuff injuries and throwing mechanics and other areas of Physical Therapy rehab. He can be reached at breid555@aol.com. The views expressed in this column are his own.

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