Achilles tendon tightness is a risk factor for<unk> . It can lead to decreased dorsiflexion of the foot. Heel bone with heel spur (red arrow) Thickened<unk>  fascia in ultrasound<unk>  is usually diagnosed by a health care provider after consideration of a person's presenting history, risk factors, and clinical examination. Palpation along the inner aspect of the heel bone on the sole may elicit tenderness during the physical examination. The foot may have limited dorsiflexion due to excessive tightness of the calf muscles or the Achilles tendon. Dorsiflexion of the foot may elicit the pain due to stretching of the<unk>  fascia with this motion. Diagnostic imaging studies are not usually needed to diagnose<unk> . Occasionally, a physician may decide imaging studies (such as X-rays, diagnostic ultrasound, or MRI) are warranted to rule out serious causes of foot pain. Other diagnoses that are typically considered include fractures, tumors, or systemic disease if<unk>  pain fails to respond appropriately to conservative medical treatments. Bilateral heel pain or heel pain in the context of a systemic illness may indicate a need for a more in-depth diagnostic investigation. Under these circumstances, diagnostic tests such as a CBC or serological markers of inflammation, infection, or autoimmune disease such as C-reactive protein, erythrocyte sedimentation rate, anti-nuclear antibodies, rheumatoid factor, HLA-B27, uric acid, or Lyme disease antibodies may also be obtained. Neurological deficits may prompt an investigation with electromyography to check for damage to the nerves or muscles. An incidental finding associated with this condition is a heel spur, a small bony calcification on the calcaneus (heel bone), which can be found in up to 50% of those with<unk> . In such cases, it is the underlying<unk>  that produces the heel pain, and not the spur itself. The condition is responsible for the creation of the spur though the clinical significance of heel spurs in<unk>  remains unclear. Imaging Medical imaging is not routinely needed. It is expensive and does not typically change how<unk>  is managed. When the diagnosis is not clinically apparent, lateral view X-rays of the ankle are the recommended imaging modality to assess for other causes of heel pain, such as stress fractures or bone spur development. The<unk>  fascia has three fascicles-the central fascicle being the thickest at 4 mm, the lateral fascicle at 2 mm, and the medial less than a millimeter thick. In theory,<unk>  becomes more likely as the<unk>  fascia's thickness at the calcaneal insertion increases. A thickness of more than 4.5 mm ultrasound and 4 mm on MRI are useful for diagnosis. Other imaging findings, such as thickening of the<unk>  aponeurosis, are nonspecific and have limited usefulness in diagnosing<unk> . Three-phase bone scan is a sensitive modality to detect active<unk> . Furthermore, a 3-phase bone scan can be used to monitor response to therapy, as demonstrated by decreased uptake after corticosteroid injections. Differential diagnosis The differential diagnosis for heel pain is extensive and includes pathological entities including, but not limited to, the following: calcaneal stress fracture, septic arthritis,calcaneal bursitis, osteoarthritis, spinal stenosis involving the nerve roots of lumbar spinal nerve 5 (L5) or sacral spinal nerve 1 (S1), calcaneal fat pad syndrome, metastasized cancers from elsewhere in the body, hypothyroidism, gout, seronegative spondyloparthopathies such as reactive arthritis, ankylosing spondylitis, or rheumatoid arthritis (more likely if pain is present in both heels),<unk>  fascia rupture, and compression neuropathies such as tarsal tunnel syndrome or impingement of the medial calcaneal nerve. A determination about a diagnosis of<unk>  can usually be made based on a person's medical history and physical examination. When a physician suspects a fracture, infection, or some other serious underlying condition, they may order an X-ray to investigate. X-rays are unnecessary to screen for<unk>  for people who stand or walk a lot at work unless imaging is otherwise indicated.
Plantar fasciitis
Osteoarthritis
Diabetic sock
Heel pad syndrome
Ischemic fasciitis
Reactive arthritis
Ankylosing spondylitis
Sprained ankle