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February 2014

Podiatrist San Antonio discusses alternate causes of heel pain

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Most heel pain is caused by mechanical issues such as heel pain due to plantar fasciitis.  There are numerous causes of heel pain so getting a proper diagnosis is important.  I see a number of patients with heel pain that they beleive is caused by plantar fasciitis but the symptoms are not relieved by common treatments for plantar fasciitis.   Such cases often involve other causes of heel pain.

Here is a partial list of heel pain causes:

1) Gout       Gout is a metabolic disease in which the body collects too much of a waste product, uric acid.  Uric acid levels can be raised because the body makes too much uric acid or because it has difficulty excreting it.

2) Rheumatoid arthritis    Rheumatoid arthritis is a form of arthritis due to antibodies formed to the bodies own tissues, most commonly tissues in joints.  It is a fairly common cause of heel pain.

3) Reiter's syndrome, ankylosing spondylitits and psoriatic arthritis   This group of arthritic conditions are known as HLA-B27  arthritides due to the gene involved and can cause heel pain.

4) Osteoid osteoma  This is a benign tumor of the heel bone that often causes heel pain at night.

5) Stress fracture   A stress fracture is a fracture, often a hairline fracture, that is caused by overuse.  The best way to visualize a stress fracture is to take a paper clip and bend it several times. It may break in two by the fourth bend but consider if that paper clip is normal after it has been bent 3 times.  A magnifying glass or microscope would show tiny fractures in the paperclip at that point.  Unlike the paper clip, our bodies are building up tissue and breaking them down.  If the breakdown process exceeds the repair then stress fractures can occur.  Stress fractures are more likely to occur when bone is weakened as in osteoporosis or osteopenia.

6)  Infections   Infections of the heel bone can occur due to direct trauma such as puncture wounds or spread from nearby wounds.   Infections in other parts of the body such as dental infections can spread by the blood to the heel.