Heel Pain Not Improving With Treatment: Maybe Its Not Plantar Fasciitis Part 2

Continuing on from last week's topic, I will finish my discussion of causes of heel pain that do not involve the plantar fascia, but are mistaken for plantar fasciitis anyway.

Inflammation from rheumatoid arthritis and other inflammatory diseases
There are a whole group of conditions that cause inflammation throughout the body to bone and joint tissue.  These conditions are called systemic arthropathies, and there are numerous diseases in this category.  Fibromyalgia is also part of this group.  Some inflammatory bowel diseases can also cause bone and joint pain, especially in the heels.  The tissue covering the bottom of the heel bone will become inflamed and painful, and fluffy bone spurring can occur.  Differentiating these conditions from plantar fasciitis can be difficult, as the heel is painful in a similar location in each condition.  The contribution of these conditions should be considered when heel pain is not responding to traditional treatment.

Bone cancer
Bone tumors do develop in the foot, both benign and malignant, and some cancers elsewhere in the body can metastasize to the foot.  Malignant bone cancer in the foot is RARE, but it can happen and in its early states can cause heel pain if the heel bone is involved.  More commonly, but still rare overall, benign bone tumors can develop that cause similar heel pain.  Most of the time these lesions are seen on regular x-ray, but in their earliest stages no bone changes are immediately visible.  Despite their rarity, if heel pain does not respond at all to treatment, repeat x-rays are a good idea to rule out these rare tumors, and any suspicious findings should be followed up with a CT or an MRI.  Benign bone tumors are usually easily addressed by simple removal and bone packing to fill the resulting gap, but malignant life-threatening tumors may need more aggressive care, including leg amputation to save one's life.

Foreign body
A final common cause of heel pain that does not involve the plantar fascia can be the retention of a foreign body in the skin or deep heel tissue from a previous puncture wound.  Puncture wounds of small sharp objects can sometimes be missed or dismissed as a more minor injury.  The material that is left behind in the skin will cause an inflammatory reaction, and even be walled off by the body inside a capsule of sorts.  The resulting inflammation and/or mass in the heel will cause heel pain, and can be mistaken for plantar fasciitis if it is in a specific location.

As you can see, there are some conditions that cause heel pain and have nothing to do with the plantar fascia, which causes most cases of heel pain.  Because symptoms can be similar, it is not uncommon for an inaccurate diagnosis to be reached based on a physical exam.  These should be considered if one does not respond well to the usual treatment course for plantar fasciitis, and should especially be ruled out before progressing to surgery for fasciitis.

I will be taking a holiday break from blogging for the next two weeks.  Look for new posts starting the first week of January.  Happy Holidays everyone!
Until next time,
Scott R. Kilberg DPM

www.inpodiatrygroup.com - foot surgeon, podiatrist in Indianapolis
thediabeticfoot.blogspot.com - diabetic foot problems
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A foot doctor in Indianapolis Noblesville Fishers Carmel Westfield and Fortville Indiana.