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Heel pain but only when standing not when walking

by Joey
(Boerne, Tx)

I have pain in my left foot only and have had this problem for about 10 years. My heel hurts only when I stand and not when I walk. I have a very high arch and wear custom orthotics. I have worn a night splint, done stretching exercises, massage therapy and cortisone shots and still no relief. The only relief is to sit down. I am in good physical condition and exercise regularly. I have had x-rays and an MRI but nothing was discovered. Could I possibly have tarsal tunnel syndrome instead of plantar fascitis? Any help would be appreciated I am about to go crazy!


ANSWER

Hi Joey,

I think it is important to note that not all heel pain is plantar fasciitis. People with high arched (cavus) foot types tend to put a lot of pressure directly on the heel, so there is a fair chance that your pain is an inherent problem directly in the heel bone.
Although I cannot rule out plantar fasciitis as the source of your heel pain, three possible causes do come to mind.
1. Have you been diagnosed with a heel spur. Even though a heel spur is nothing more than the calcification of the plantar fascial ligament where it attaches into the heel bone, if there is a spur that is large enough, this protrusion of bone might be enough to cause pain primarily when standing as the spur would be pressing directly into the ground.
2. The possibility of a bone bruise of the heel bone. As I mention in my section on heel pain if there is not enough fat under the heel bone to cushion it, then the heel bone itself may become painful and this would tend to happen the more you stand and the less you walk.
3. A bursitis. This one would be a little less remote but an inflamed bursal sac on the bottom of the heel might tend to hurt more when standing compared to walking.
Those are some of the things that come to mind. Of course it might just be plantar fasciitis and the type of orthotic that you are wearing may not be the right kind. Is the heel of the orthotic cushioned? Does the orthotic actually support your arch when you stand, thus taking pressure off the heel bone?
If you answered no to either one of those questions then your orthotic may not be helping you.
I would say this. If you presented to my office with your history, I would consider performing an MRI on your foot to rule out the more esoteric conditions that might be causing heel pain. Although tarsal tunnel can certainly be the cause of some heel pain, I am not so sure in your case.
Your best bet? Get a second opinion.

Marc Mitnick DPM
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