Skeletal Origin |
Acute calcaneal tuberosity/body fracture | High-energy axial overloading through heel such as from a fall or MVA | Patients often unable to ambulate; acute ecchymosis and swelling of heel | Plain radiography |
Calcaneal stress fracture a | Overuse injury associated with sudden increase in athletic activity; deep, dull pain in calcaneal tuberosity worsened by walking on hard surfaces | Reproducible pain with simultaneous medial and lateral compression of calcaneous (squeeze test a ) | MR imaging, single-phase bone scan |
Subtalar and talonavicular arthritis b | Insidious lateral and medial heel pain, respectively, and relieved with rest | Pain, swelling, and stiffness worsened by weight-bearing activity | Plain radiography |
Soft Tissue Origin |
Acute plantar fascia rupture | Acute plantar "pop" followed by severe heel pain with foot swelling | Ecchymosis and swelling in plantar heel and midfoot; palpable mass under medial arch may exist | Noncontrast MR imaging |
Fat pad atrophy | Centrally located heel pain worsened by walking on hard surfaces; most common in elderly patients | Deep pain with palpation of medial aspect of heel | MR imaging |
Insertional Achilles tendonitis | Posterior heel pain worsened by ascending stairs or hills | Point tenderness over posterior tendon of foot; Achilles contracture may be present | Noncontrast MR imaging |
Retrocalcaneal bursitis | Pain in posterior heel near calcaneal insertion of Achilles tendon; common in runners | Pain with passive dorsiflexion and eversion of the foot | Noncontrast MR imaging, plain radiography |
Neurogenic Origin |
Tarsal tunnel syndrome | Pain radiating from the medial malleolus into the foot, which may worsen throughout the day; improves with rest of intrinsic foot muscles | Plantar parasthesias elicited by tapping the tibial nerve behind the medial malleolus (Tinel sign); plantar sensory loss or atrophy | Electrodiagnostic studies, MR imaging, US |
LPN/MCN entrapment | Plantar foot pain consistent throughout day | LPN: tender over lateral plantar aspect of foot; possible atrophy of abductor digiti minimi. MCN: tender over plantar aspect of medial arch; no muscle atrophy | Electrodiagnostic studies, MR imaging, US |
S1 radiculopathy | Radiating pain traveling down the posterior aspect of leg | Diminished ankle jerk reflex and weakened plantar flexion of foot; weakened toe walking | Electrodiagnostic studies, MR imaging, US |
Peripheral neuropathy c | Risk factors for peripheral neuropathy c ; gradual onset of diffuse pain, numbness or tingling in foot that may progress to sharp, jabbing pain | Decreased sensation to vibration, light touch, temperature, and pain, hair loss, smooth skin, muscle atrophy, ulceration, and progressive clawing of toes | Electrodiagnostic studies, nerve biopsy, noncontrast MR imaging, US |