Heel pain is the most common symptom of foot and ankle outpatients. Heel pain usually presents with pain at bottom of heel which is commonly plantar fasciitis or at the back of the heel which is commonly Achilles tendinosis. But all heel pain are not plantar fasciitis or Achilles tendinosis, there are causes other than these two also. Sometimes atrophy of plantar fat pad, traumatic inflammation of fat pad, or lateral plantar nerve compression can also elicit pain at the bottom of foot. Compression of the lateral plantar nerve is the most disabling and difficult differential diagnosis of plantar fasciitis. Achilles tendinosis or more precisely insertional Achilles tendinosis can be associated with few other abnormalities around it like prominence of heel bone; ‘Haglund deformity,’ inflamed bursa around the tendon. A tight gastrocnemius muscle is the common factor for most of these heel pain, which causes restricted ankle dorsiflexion in extended knees and produces overloading. There is common misbelief that bone spur causes pain, but it’s not true. It is the degenerated plantar fascia and Achilles tendon which initiates the pain.

Whatever the cause of heel pain maybe it rarely requires surgical management. Rest analgesic and stretching exercise are the key elements for heel pain treatment.