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Pain under the heel, is it always plantar fasciitis?

The heel (or rearfoot) is a complex structure made up of the calcaneus (heel bone) and talus bones. Under the heel, the most superficial (closest to the skin) structure is the heel fat pad. Unlike fat stored across the rest of the body, this structure is adapted to dissipate pressure points from the heel bone when standing and walking.

To further aid in pressure reduction a bursa (fluid-filled sack) is also located deep in the fat pad. Occasionally, this fat pad can become atrophied (smaller) due to normal aging processes, excessive use of locally injected corticosteroids and increased body mass. The result of an atrophied fat pad is less cushioning and therefore increased pressure and pain at the heel.

The bursa often becomes sore as it takes up the slack from the atrophied fat pad. Treating this condition with standard modalities for plantar fasciitis such as stretching and strengthening will likely do little to help; other more targeted approaches are required. Other conditions that can occur below the heel include nerve entrapment between the small arch muscles, deep ligament sprains, stress fracture of the calcaneus and arch muscle and tendon strains.

The above issues require a unique treatment plan to achieve the best possible outcome. Call to see 4 Life Podiatry and we will develop your treatment plan.

By Dr Matthew Storer


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