When Your Heel Pain Just Won’t Go Away

Eric H. Williams MD
Specializing in reconstructive surgery and pain relief in the Greater Baltimore area.

Heel pain is extremely common. So if it is something that stubbornly forces itself upon your daily life, you are far from alone.

In a majority of cases, heel pain is quite treatable, and often with conservative, non-surgical methods. But if you have seen experts, tried multiple attempts at treatment, and nothing still seems to work, then this can be a very frustrating problem, given the financial expense, time spent and persistent discomfort  despite your attempt to address it.

If your heel pain persists, then it may be time to consider whether the problem is caused by a peripheral nerve entrapment, a cause of chronic heel pain that is frequently overlooked.

We will be further discussing what nerve-related problems may contribute to chronic heel pain, but it’s equally important to go over other potential causes of this symptom, too.

The Standard Approach to Heel Pain

Heel pain is a deceptively simple-sounding symptom. Your heel hurts. Making it stop should not be so difficult, right?

What can make heel pain tricky, however, is the fact that it can stem from a variety of different conditions, and there may be different factors that can contribute to each of these conditions. Unless you are treating the correct sources of your heel pain, your relief can be limited at best.

It is also very important to communicate accurately with your physicians the exact location, character, and quality of your heel pain. For instance, heel pain on the sole of your heel may have a different cause than pain in the back of your heel or the inside or outside of the heel. We’re talking about a small body part, but there are plenty of moving parts within that can contribute to the sensation of “heel pain.”

Let’s consider plantar fasciitis, for example. This is one of the most common causes of plantar heel pain, or pain where your heel strikes the ground. It occurs when the plantar fascia, a thick band of tissue that runs beneath and supports the foot, is overly strained or aggravated. Classically, if your heel pain is most severe first thing in the morning or after a long period of being still—and improves slowly as you move through the day—plantar fasciitis might be the correct diagnosis.

But that’s only part of the picture. It’s not enough to know you have plantar fasciitis; you must also know why. Are the shoes you’re wearing causing excess stress on your feet? Are you overworking your plantar fascia as part of your job or workout routine? Do you have an overly tight calf muscle? It is even possible for an abnormality in your foot structure to distribute weight unevenly across your feet and be the source of the strain.

And this just one form of heel pain.

What we’re trying to say is that heel pain can be more complex than expected. Some people might try one or two changes and be understandably disappointed if they aren’t as effective as they had hoped. This often just means they haven’t found the correct approach to addressing their pain yet.

When Should You Consider Seeing Us for Chronic Heel Pain?

The first question regarding any case of heel pain is: have you seen a podiatrist or foot and ankle orthopedic specialist?

Podiatrists and orthopedists are experts in heel pain. They see patients with this condition more than anyone else (it’s often the top complaint their patients have by far), and they have the most direct training and tools to address it. A properly trained podiatrist or foot and ankle orthopedic specialist is a clearly recommended first point of contact.

Narrowing down the specifics of heel pain can be tricky even for a foot and ankle specialist, though. An initial treatment may not be effective, but there are many methods that may work better for some patients than others. These can include custom orthotics, physical therapy, changes in footwear, biologic injections and medications, and advanced laser treatments to help accelerate soft tissue healing, among other forms.

But if several treatments have not worked out, and it has been more than 6 months that you have been enduring your heel pain, it may be time to consider contacting us to investigate your condition from a more nerve-focused perspective.

It is worth noting that this situation is not typical of most heel pain cases. But if you’re reading this blog, your case is likely not typical! It is also worth noting that a peripheral nerve-related cause is likely the most often overlooked source of heel pain.

A peripheral nerve entrapment causing heel pain may be even more likely if:

  • You seem to have tried everything with your foot and ankle specialist; even up to a plantar fascia release or other surgical procedure.
  • You are told there are no “abnormal findings” on your x-rays or other imaging tests.
  • You feel tingling, numbness, shooting, or “electrical” pain along with (or instead of) “standard” pain.
  • You have diabetes or other conditions that may cause swelling or damage to your nerves.

 

How Heel Pain May Be a Nerve Issue

The term we tend to use for chronic heel pain is “refractory heel pain.” If you happen to hear that, “refractory” simply means “not getting better.”

When considering nerve-related causes of heel pain, one of the first considerations will be some form of tarsal tunnel syndrome.

The tarsal tunnel is a narrow space along the inner edge of the ankle. It contains and protects tendons, blood vessels, and nerves—with the one we’re especially interested in being the tibial nerve and its branches.

Certain factors can cause the tibial nerve or its branches to be compressed within the tarsal tunnel, causing painful symptoms. This can happen for a variety of reasons, including swelling of the nerve itself, structural abnormalities, previous injuries to the area, and the buildup of scar tissue around the nerve.

In our experience, the most common nerve entrapments leading to pain on the inside of the heel and the sole of the heel are specifically the calcaneal nerve and lateral plantar nerve—two branches of the tibial nerve in the heel.

A Quick Screening for Nerve Entrapment in the Heel

First, cross your left foot over your right knee, so you are looking at the inside of your ankle. 

Tap with your index and middle finger with mild force (as if lightly knocking on a door) along the inside of the heel, just in front of the Achilles tendon and down into the bony part of the heel. Think of the area as the triangular portion just beneath that bony bump on your ankle.

If you have any sense of “electrical” pain, tingling or a “funny bone” sensation along the heel or arch, there is an extremely good chance that these nerves are compressed and contributing to your pain.

While tarsal tunnel syndrome can be treated via non-surgical methods in some cases, surgery is often necessary in others. Tarsal tunnel surgery will require preparing for both your recovery period and potential rehabilitation/physical therapy. These are matters we would fully discuss with you on a personal basis, as conditions can change from patient to patient.

There are other potential sites of nerve stress or trauma we may need to investigate, as a nerve does not necessarily need to be troubled close to the site of pain to be causing it. Nerve damage anywhere on a pathway can exhibit symptoms at different locations along it.

It is also very possible that a patient may have more than one different cause of heel pain, such as nerve entrapment and plantar fasciitis. If one source is being treated and the other is not, heel pain may persist. Our practice is unique in that we simultaneously team up with foot and ankle specialists to ensure that all angles are being covered.

Do Not Lose Hope for Relieving Your Heel Pain

Heel pain is a very stubborn problem that has very real impacts on day-to-day life. The frustrations of not finding a solution—especially when experts have been consulted—can be intense, and they are absolutely valid.

But heel pain can be treated, and you do not deserve to keep having to endure it all the time. If it has been more than 6 months with chronic heel pain, and you have tried multiple professional treatments, consider a consultation with Dr. Williams.

You can reach our Towson office at (410) 709-3868 or fill out our online contact form to get in touch.

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