Heel Pain: Clinical Pearls Blog

Gerard Kiernan, MD, FAAFP, FHMClinical Pearls

Heel pain pearl of wisdom cover

Heel Pain

Clinical Pearls of Wisdom Q&A Case

Heel pain is defined as physical discomfort on the back or the underside of the heel that may make walking uncomfortable or difficult. Heel pain can have causes that aren't due to underlying disease. Examples include poorly fitting shoes, wearing high heeled shoes, prolonged period on feet, overuse such as long walks or marathons, sprains, strains, or trauma.

Try this heel pain board review question-based case and pick up another "pearl of wisdom" from Med-Challenger.

Clinical Scenario:

A 48-year-old woman presents with right heel pain. She describes sharp heel pain that is bad in the morning, abates somewhat in the course of the day, and then returns by the end of the workday.  It started insidiously and has progressed over the past three months. She does not recall any specific inciting injury.

She works as a picker in a warehouse and is on her feet during the workday. Her prior medical history includes hypertension, for which she takes amlodipine. Her prior surgical history is significant only for cesarean section. There is no family history of rheumatologic disorders.

On examination, her heel pain can be reproduced by firm palpation of the anteromedial heel. There is no edema, erythema or warmth.

Question:

What are the most appropriate next diagnostic / therapeutic steps for this patient with heel pain?

Answer Options:

 Obtain a lateral foot x-ray, looking for calcaneal spur, and, if present, consider extracorporeal shock wave treatment.

Inject calcaneal tuberosity with dexamethasone and lidocaine, and use supportive taping.

Recommend rest, cushioned shoe inserts, home stretching exercises, and simple analgesics.

Order erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and an ultrasound.

See the Answer:


About the Author:

Gerard Kiernan, MD, FAAFP, FHM is a Dartmouth-Hitchcock Clinic hospitalist in Keene, NH. He attended the University of Rochester School of Medicine and Dentistry, followed by a Family Medicine residency at the University of Wisconsin, Madison, where he was a chief resident. Dr. Kiernan is a Lean Six Sigma Greenbelt and has led hospital medicine quality improvement efforts. He is a fellow of both the American Academy of Family Physicians and the Society of Hospital Medicine. He has achieved the Recognition of Focused Practice in Hospital Medicine offered through the AAFP and ABIM via their joint examination pathway.

About Clinical Pearl of the Month:

Med-Challenger's Clinical Pearl Blog Series is a recurring segment of Med-Challenger's popular Medical Education Blog. Med-Challenger provides online medical education products and services to physicians, nurses, and other medical specialists as well as medical training programs and healthcare groups world-wide via its web-based medical education library and world-class assessment platform at challengercme.com.

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