Don’t Self-Diagnose Your Heel Pain
by Dr. Rock Positano
Heel pain is one of the most common ailments that is found in the active population. Unfortunately a painful heel can be severely debilitating if not properly diagnosed and treated. It may not be life threatening but it is certainly quality of life threatening and affects a person’s ability to walk, stand, exercise and participate in social activities.
Heel pain is the great impersonator and can signify a wide range of medical problems from a common musculoskeletal problem known as plantar fascia to a cancer metastasis in the heel bone from breast, prostate, lung and other areas. There is no such thing as simple heel pain and this complaint should never be trivialized and relegated to an internet search. All too often we will evaluate a patient who has heel pain for over a year only to find that there is a more serious underlying problem such as a tear in the plantar fascia.
Interestingly, heel pain is one of the most misdiagnosed musculoskeletal conditions. Physicians often misdiagnose heel pain as plantar fasciitis based on the clinical exam alone or in conjunction with an MRI, without performing a diagnostic ultrasound to rule out other possible causes. The wrong diagnosis can not only prolong a patient’s suffering and decrease quality of life, but can do more harm than good if the incorrect treatment is prescribed. For example, it can lead to unnecessary surgery. Even worse, it can trigger serious systemic health issues such as cardiovascular disease, Type 2 diabetes, obesity, osteoporosis, and depression, due to inactivity and lifestyle changes caused by pain.
Many clinicians as well as the public often conclude that MRI should be the diagnostic test of choice when looking at a heel injury, however, technical advances and higher-frequency transducers have made diagnostic ultrasound technology more desirable than MRI in the diagnosis of foot pain, and it’s much less costly and does not require am often claustrophobic environment associated with the MRI tube.
We published a 2015 study conducted by our Non-surgical Foot and Ankle Service and Heel Pain Center at Hospital for Special Surgery (HSS) and found that a safe and painless diagnostic ultrasound test can pinpoint the exact cause of heel pain and ensure the most effective and safe treatment.
Our findings led us to conclude that diagnostic ultrasound can effectively and safely identify the true cause of heel pain. The high prevalence of plantar fibromas and plantar fascial tears cannot be determined by clinical examination alone, and, therefore, ultrasound evaluation should be performed to confirm the diagnosis. This specialized diagnostic test could spare many people an incorrect diagnosis, potentially harmful treatment and needless suffering.
Foot pain isn’t just a unidimensional issue. Our experience both anecdotally as well as scientific research has revealed that a painful foot will quite often cause pain and dysfunction elsewhere in the body especially the knee, hip and lower back. What starts in the foot most likely will travel up the motion chain to these other body parts.
Bottom line- Don’t self-diagnose your heel pain. If it persists more than a week you should seek medical attention. Wearing high heels, flats and athletic shoes should never be put on the shelf.
Dr. Rock G. Positano has been on staff at HSS since 1991 and is internationally known for his non-surgical approach for the treatment of foot disorders. He serves in the capacity of Founder and Director of the Non-surgical Foot and Ankle Service and the Joe DiMaggio Heel Pain Center at Hospital for Special Surgery. He has authored and edited numerous peer-reviewed articles and has served as the editor of 13 medical textbooks ranging from foot and ankle orthopedics, heel disorders, to sports medicine.
