What Causes Outer Heel Pain
A 34-year-old healthy female presented to the podiatrist at the Sydney heel pain clinic complaining of outer heel pain. The discomfort that she was experiencing was located laterally, along the side of her right heel just below her ankle bone. The patient was sure that she was suffering from a condition known as plantar fasciitis, but she had not had this diagnosed by a professional or healthcare practitioner. She had carried out her own online research and as many patients do they come up with their own diagnosis. Quite often many patients present with lateral heel pain or medial heel pain and will inform the podiatrist that they have plantar fasciitis, when in fact they do not. This patient had been experiencing outer of heel pain for only seven days and she reports that the pain came on very suddenly. She advises the podiatrist that she is otherwise a healthy individual and has never experienced foot problems before. She is very active and plays tennis, netball and enjoys hiking. This patient ‘s footwear is extremely supportive and she explains to the podiatrist that she never walks barefoot or uses ballet flats, flip flops, thongs or non-supportive sandals. She is not overweight and it is unlikely that body weight is a contributing factor in her outer heel pain. She explains to the podiatrist that there is also some throbbing and shooting pain along the lateral side of her heel, and that this discomfort runs along the side of her foot toward her little toe. She has been applying cold packs to the area on a day-to-day basis and explains to the practitioner that this has helped to reduce the pain temporarily.
What Caused the Outer Heel Pain?
This patient explains to the podiatrist that her outer heel pain came on following a long game of tennis that lasted approximately 2 hours.
She remembers leaving the tennis court with a throbbing sensation at a sharp pain along the outer heel. She sat down in the changing room and removed her shoes and the outer heel pain increased while she was stationary. When she stood up to move she was unable to bear weight on her right foot due to extreme pain. She was forced to hobble back to her car. While she was driving home the outer heel pain increased further, and there was severe throbbing. After arriving home she found it virtually impossible to walk from her car to the front door of her apartment block. She was unable to walk unassisted due to the extreme outer heel pain, and she explains to the podiatrist that she had to hold on to her husband’s arm with one hand and the wall with the other hand.
Physical Examination of the Outer Heel Pain
In order to diagnose the condition and inform the patient of the cause of her outer heel pain, the podiatrist carried out a physical examination of the right foot. When finger pressure was applied to the peroneal tendon insertion, at the base of the fifth metatarsal the patient reported significant heel pain. She retracted her foot and displayed extreme discomfort in the chair. The podiatrist explained to the patient that the cause of her outer heel pain was in fact inflammation and possible tearing of the peroneal tendon at its insertion, and that she did not have ther symptoms of plantar fasciitis.
The podiatrist carried out further biomechanical measurements and was able to determine that the patient demonstrated extremely limited range of motion throughout her ankle joints due to short and tight calf muscles. It was explained to the patient that this was probably part of the cause of her outer heel pain, as the Achilles tendon would have been applying excessive force through the posterior aspect of the heel, causing an early heel lift. This would in turn overload the peroneal muscle and tendon.
It was explained to the patient that in addition to the specific treatment for the peroneal tendon, in order for the outer heel pain to reverse completely, it would be necessary to stretch and soften the calf muscles. This would involve physiotherapy and stretching outside of the clinic on a daily basis.
Imaging For Out of Heel Pain
In order for the podiatrist to confirm the diagnosis and measure the severity of the outer heel pain, this patient was referred to the imaging centre for ultrasound. The report conclusively revealed that the cause of the outer heel pain was inflammation, and a partial tear in the peroneal tendon close to its insertion.
The patient was informed of this diagnosis over the phone and an appointment was made for her to return to the clinic for treatment.
It should be noted that plantar fasciitis is not the only condition that causes pain in the heel, and more often than not the pain is medial. If you are experiencing outer heel pain there is a good chance that you are suffering with a condition other than plantar fasciitis.
Written by Karl Lockett