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Rheumatology clinic

A practical approach to heel pain

Lou McGuigan

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Abstract

Finding the cause of heel pain can be difficult and frustrating. Moreover, a number of medical and paramedical specialists have interest in the problem without necessarily having the expertise to give consistent relief of symptoms. This article outlines a commonsense approach to diagnosis and management.

Article Extract

Clinical features

Heel pain can present in a variety of ways. It can be acute, severe and highly localised, or may be a transient manifestation of a systemic illness such as Reiter’s syndrome or ankylosing spondylitis. More typically, however, the pain is a diffuse discomfort that is not well localised.

Patients tend to be middle-aged or older. They are often overweight (but not always), and pes planus with overpronation is typical (Figure 1). Specific questioning usually reveals that the pain is worse in the morning on first arising or when the patient stands from a sitting position and starts walking.

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