heel neuroma

Although I have a more extensive discussion of heel pain on another page on this site, I thought I would devote a page to a condition that is not often recognized in the diagnosis of heel pain.

A heel neuroma is basically a nerve entrapment that occurs amongst the inflammation that occurs in heel pain.

Most patients will present to the doctors office with a complaint of heel pain on the bottom of the heel. After the interview, examination, x-rays and any other tests the doctor may perform a diagnosis of plantar fasciitis or heel spur is usually made. There are other less common conditions that may also cause heel pain.

What I have noticed in people where the diagnosis of plantarfasciitis or heel spur is made is that in a good percentage of these people there is also involvement of the “calcaneal nerve” which is a small branch that comes off the larger nerve. This nerve is located on the inside part of the heel and travels underneath the heel.

Generally, from the constant pounding that the heel takes both in walking and exercise the nerve is traumatized. This condition can also be brought on faster by a degeneration of the fat pad on the bottom of the heel.

In those cases where the heel pain gets worse as the patient ambulates a diagnosis of heel neuroma has to be considered.

The picture below demonstrates an inflamed medial calcaneal nerve.

So in addition to treating the heel pain on the bottom of the foot the heel neuroma must also be treated.

Strapping the heel in an effort to keep all the fat underneath the heel can be helpful. The patient should avoid wear only shoes with a back on them (no sandals, mules, slides, etc.) because the closed in shoe will help keep the fat underneath the heel.

Medical treatment in my practice consists of multiple, as many as seven, sometimes eight injections of denatured alcohol which attempts to sclerose or deaden the nerve. I have found this treatment to be very effective in at least 80 percent of the cases.

The point to take away from this article is that if you are suffering from heel pain and have had treatment that does not seem to be making the pain go away discuss the possibility of a heel neuroma with your doctor.