Types of Heel Pain

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Many patients ask themselves, “Do I have plantar fasciitis?”. Many patients assume they have plantar fasciitis as it is a fairly well known term but there are many types of heel pain. The types of heel pain shown in the video below are the most common types of heel pain. Based on the location and the type of pain you are experiencing, it is easy to differentiate between let’s say plantar fasciitis or achilles tendonitis, plantar fasciitis or fat pad syndrome, etc. Once you have a proper diagnosis, then you can go about treatment for heel pain successfully.

What is Fat Pad Syndrome?

The most common condition we see that tricks patients into thinking they have plantar fasciitis is fat pad syndrome. Some patients can have both! There are a few key differences in the history and exam to differentiate between the two. Patients with fat pad syndrome have pain consistently throughout the day, worse barefoot, and stretching does not help. Plantar fasciitis is characterized by pain that is worse in the morning, but improves to a degree as you walk around. Stretching and rolling usually help temporarily alleviate symptoms. Fat pad syndrome needs to be protected with taping to support the fat pad, wearing heel cups in your shoes, and wearing cushioned shoes throughout the day. Once the heel is protected, inflammation will go away and the symptoms improve.

Types of Heel Pain

Is a Plantar Heel Spur the Cause of My Pain?

One question we often get asked is if a patient has plantar fasciitis or heel spur. The reality is, is that people may have heel spurs and never have pain in the heel. Or patients may have plantar fasciitis symptoms and find a bone spur after having an x-ray. Patients may experience plantar fasciitis pain with a heel spur or they may not.

A heel spur is only present if there has been enough tension or pulling from the plantar fascia. This constant tension results in the heel bone becoming elongated at the plantar fascia attachment site. This usually occurs from long standing tension in the plantar fascia from high arches, biomechanical stress, hallux limitus, etc. Treatment is same if a patient has plantar fasciitis or heel spur.

Achilles Spurs and Haglund’s Deformity

Heel spurs can also be seen on the back side of the heel where the Achilles tendon attaches. Achilles tendonitis can cause pain in the back of the heel. This type or Achilles tendinopathy is termed insertional Achilles tendonitis as the pain is at the site of where the tendon inserts into the heel bone. Similar to the plantar heel spur, some patients may have an Achilles heel spur, others may not. Treatment of insertional Achilles tendinitis, with or without a spur is the same.

A more obvious deformity called a Haglund’s deformity, is a overgrowth on the backside of the heel where the Achilles attaches. The tendon becomes inflamed when this deformity rubs on the soft tissues, especially in shoes. We most comonly see this in patients who have had chronic Achilles tendinopathy or have other structural causes of this deformity such as high arches, hallus limitus, and or rear foot varus

Less Common Types of Heel Pain

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Less common types of heel pain but still seen in the clinic are peroneal tendonitis and posterior tibialis tendonitis. Peroneal tendonitis can affect the outer portion of the heel while posterior tibialis tendonitis can affect the inner heel area. Usually the pain is at the sides of the heels but we have seen some cases where pain is on the bottom/side of the heel. Again patients are quick to say they have plantar fasciitis, but with a pinpoint exam, we can rule in these other tendons as being the pain generators, not the plantar fascia.

The heel is a small area and can be relatively simple to diagnose the cause(s) of heel pain. However, many people end up having different conditions than what they thought they had. This ultimately delays the recovery process by not receiving the correct treatment plan initially. Schedule with one of our sports chiropractors today to get you on the correct path to recovery. Peak Form Health Center is located in Mission Valley, San Diego.

Peroneal tendonitis treatment san diego

Peroneal Tendonitis Treatment

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What is Peroneal Tendonitis?

Peroneal tendonitis is characterized by pain and tenderness on the outer part of the foot and ankle. In some cases, there can also be swelling around the tendons and tendon sheaths around the outer ankle. The two main peroneal muscles originate on the outer lower leg bone (fibula). The longer peroneal muscle runs around the outside of the ankle, and wraps around the side of the foot to the bottom of the foot and inserts into the midfoot (medial cuneiform) and the base of the 1st metatarsal. When these muscle become excessively tight, the tendons become inflamed, rub against the side of the ankle and foot which can become quite painful. Check out our video below describing our approach to treating peroneal tendonitis and continue reading below.

What are the Causes?

When the peroneal muscles sustain a higher load than what they are capable of handling, peroneal tendonitis can occur. Peroneal tendonitis can be a result of ankles sprains, repetitive strain (ballet dancing, jumping, running), people with high stiff arches in their feet, and from compensation due to other injuries (plantar fasciitis).

High stiff arches in the feet is often a presentation we see as this type of foot places more pressure on the outer half or outer third of the foot. This causes the peroneals to work much more strenuously than in feet with a more normal/flexible arches. Due to this weight distribution, these individuals are more prone to “rolling” their ankle during normal day to day walking and especially during sports (ex: Soccer). When looking at wear patterns on the bottom of shoes for a runner, we will see excessive where on the outer border of the bottom of the shoe. In many of the chronic cases of peroneal tendonitis, many patients do not know what “caused” the pain to start. When we go through a thorough exam and history, many patients have the history and characteristics described above which should be addressed for proper treatment.

Peroneal tendinopathy treatment san diego
High, stiff arches often time plays a role in the development of chronic peroneal tendonitis.

Conservative Treatment

Conservative treatment for peroneal tendonitis and peroneal tendinopathy is very successful for managing the symptoms. In our office, we usually start peroneal tendonitis treatment with Graston Technique to the peroneal muscles (The peroneous longus, peroneous brevis, and peroneous tertius) to help loosen up the muscles while promoting blood flow to the area. Active release technique, a type of myofascial release, for peroneal tendonitis may be helpful to break down adhesions and trigger points within the peroneal muscles. Most importantly, loading the peroneal muscles with proper strength training exercises will help stimulate the injured areas of the tendon while providing strengthening to avoid future reaggravation. Peroneal tendonitis rehab exercises are crucial to help the tendons heal properly.

Finding the Root Cause of Peroneal Tendonitis

In treating peroneal tendonitis, it is important to discover the root cause. As described above, if a patient has very stiff, high arches, this will place more of the body weight on the outer half of the foot which will overly stimulate the peroneal muscles. Another example is peroneal tendonitis due to hallux limitus (when the big toe has limited extension), patients will have a hard time shifting their weight towards their big toe during gait which keeps their weight on the outer half of the foot, loading the peroneal muscles excessively.

Other conditions such as plantar fasciitis can lead to peroneal tendonitis due to compensation. When the bottom of the inner heel is painful, patients unknowingly keep the weight of their body on the outer half of the foot to avoid pressing into the painful part of the heel; peroneal muscles again become strained resulting in peroneal tendonitis. Many of these patients experience outer heel pain while walking or outer heel pain while running. Another condition called cuboid syndrome causes peroneal tendonitis as the peroneal tendons run across a portion of the cuboid bone. When the cuboid bone is stiff and not moving well with cuboid syndrome, the peroneal tendons also become stiff resulting in pain.

If you are dealing with peroneal tendinopathy, please schedule with one of our sports chiropractors today. Above you will find the “schedule now” tab which will direct you to our online scheduler. You may also call our office at 619-818-4306.