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Abstract
Chronic heel pain is a common clinical entity. Ten percent of people
may experience pain under the heel at some time. So, the problem must be
taken seriously and carefully.
Studying the anatomical structures of the heel that can be the source
of the chronic heel pain is of great importance. This includes the plantar
fascia, the calcaneus, the heel pad, the subtalar joint, tendo-Achilles, and
nerves around the heel.
Special attention should be paid to the nerves around the heel
particularly, the first branch of lateral plantar nerve or nerve to abductor
digiti minimi that can be the cause of recalcitrant heel pain. It takes a lateral
course as it passes from medial to lateral immediately beneath the medial
tuberosity of the os calcis.
Heel pad is a specialized elastic adipose tissue fashioned in U-shaped
form with fibrous septae. It is organized for cushioning and shock
absorption.
Many predisposing factors may contribute to initiation of chronic
heel pain such as increased body weight, occupations that necessitate
prolonged standing and weight bearing, and different foot abnormalities
e.g. flatfoot and even cavusfoot.
The etiology of chronic heel pain had never been completely defined
and no clear definite cause is determined. The etiology may attributed to be
due to inflammation, degeneration, metabolic disorders such as gout,
trauma that is being repetitive and microtrauma, congestion of the os
calcis, calcaneal spur formation, and systemic disorders such as some
seronegative arthropathies and rheumatoid arthritis.
Proper management of chronic heel pain start with proper diagnosis.
History taking, including the site, the duration of the pain, the onset, the