Heel pain is a very common foot pathology whose etiology is not completely elucidated. Approximately 90% of cases are resolved within 10 to 12 monthsbut 10% of them become chronic and may require surgical treatment.
Alvaro Iborra, Co-director of Avanfi and head of the Foot and Ankle Surgery Unit at La Zarzuela Hospital, acknowledges: “Today, many patients with heel pain receive a diagnosis fake plantar fasciitis. In many cases, despite MRI or ultrasound reports, the fascia is normal, as many other pathologies causing heel pain are unknown.
It is considered that 10% of the world’s population will suffer from heel pain throughout their livesa real epidemic, it is therefore necessary to delve deeper into its causes.
One of the pathologies that can cause heel pain is tarsal tunnel syndromeentrapment of the posterior tibial nerve in the ankle or its final branches (medial plantar and lateral plantar nerves) in the medial arch of the heel and foot.
“The clinical picture presents with pain in the heel and sole of the foot, as if it were plantar fasciitis, which can lead the specialist to a misdiagnosis of plantar fasciitis. However, it can also cause inability to stand for long periods, to walk, burning or tingling sensation in the feetwhich gets worse as the day goes on, unlike the pain of the cold, or the morning pain of true plantar fasciitis,” he emphasizes. Manuel Villanuevatraumatologist and director of Avanfi.
Tarsal tunnel syndrome It is an often overlooked pathology.because its diagnosis is really complex and requires a lot of experience on the part of the specialist.
Correct diagnosis
Furthermore, Iborra points out, “often the usual diagnostic tests (magnetic resonance imaging, ultrasound, electromyography, etc.) are normal in peripheral neuropathies of the foot and ankle, so the diagnosis eludes and the treatment options early treatment also. To make the correct diagnosis, great specialization, clinical expertise and the use of other diagnostic tests are necessary, such as selective infiltration of anesthetic around the nerve under ultrasound guidance, ultrasound-guided neurophysiological studies or measurement of nerve pressure within the nerve and its anatomical channels in the ankle and foot.
Lack of specialization or appropriate diagnostic tests This can lead to misdiagnosis of these conditions, what we might call false plantar fasciitis.
Sometimes heel pain is caused by selective compression of a nerve in the sole of the foot, the Baxter nerve. Baxte’s neuropathyr, caused by compression of this nerve, can generate heel pain. Sometimes, mechanical heel pain (fasciitis or other cause) and neuropathic pain (due to nerve entrapment) coexist.
“Patients may experience burning or stinging sensations, tingling or electric pain. Also numbness of the heel and even the sole and/or fingers. Symptoms usually appear on the inside of the foot or heel. However, some people may experience pain in the sole of the foot or in the fifth toe due to compression of the lateral plantar nerve, which innervates this part of the foot and where the Baxter nerve originates,” explains Dr. Villanueva.
It is very common to find, in specialist consultations, very young patients (20-40 years old) suffering from poorly diagnosed or poorly resolved foot pain and who are very disabled, which does not happen, for example, with patients who have entrapment in the hand of the median nerve (the carpal tunnel).
Although the specialist considers that nerve entrapments constitute a real epidemic as a cause of heel pain, often misdiagnosed, there are other possible causes:
-
-
- Flat or hollow feet.
- Bone Spurs and Plantar Fasciitis
- Systemic diseases such as diabetes or rheumatoid arthritis.
- Fractures, tumors, metabolic diseases, etc.
-
Treatment
Treatment for heel pain must address the causes. Correct or improve foot deformities with modelsspecial shoes or surgery if necessary.
Plantar fasciitis may improve with insoles, physiotherapyselective exercises or infiltrations of different therapies. If the disease becomes chronic, surgery is necessary, an operation that can be performed in the office, without opening, under local anesthesia, in 10 minutes, with a needle, as published by the author and his team. The patient leaves the consultation.
In case of peripheral neuropathies of the foot, treatment should include antineuritic drugcorrection of metabolic or rheumatic alterations, blockages under anesthesia or radiofrequency to modulate the painful response of the nerve, all under the control of high-resolution ultrasound.
“Sometimes surgery is necessary to decompress the nerve. If there is an extrinsic cause (an accessory muscle compressing the nerve, a tumor, many varicose veins or vascular bands), it will be done open surgery with a high-power magnifying glass), but if these causes do not exist, ultra-minimally invasive surgery guided by ultrasound can be performed to decompress the ankle nerve and its main branches in the heel and foot, including Baxter’s nerve,” explains Dr. Iborra.
The patient should know that the nerve is a tissue that we call time-dependent, that is, the longer it is compressed, the more uncertain the elimination of pain will be, which is why Sometimes the decision is made to cut the nerve to leave the heel without feeling.This option would be what we call salvage surgery for chronic heel pain. Although much progress has been made in the knowledge and treatment of this very complex pathology, some patients will not fully recover, so it is essential to disseminate this pathology so as not to find undiagnosed people who suffer from this pathology, without diagnosis. , up to 20 years of age, usually at the most fertile ages of life, as we have encountered in our medical practice over the last 12 years.
