DIAGNOSIS CHECKLIST
for Heel pain

Why: to determine if acute or chronic.

Why: e.g. burning type pain may suggest nerve entrapment; throbbing pain may suggest inflammation of the joints such as Reiter's disease or ankylosing spondylitis; sharp pain over the Achilles may suggest rupture.

Why: e.g. pain under the heel worse when first stepping out of bed and standing after sitting suggests plantar fasciitis ; pain worse at night may suggest peripheral vascular disease.

Why: Children often have Sever's disease (Osteochondritis of the heel) which causes a diffuse heel pain usually in boys around age 10.

Why: e.g. falling onto the foot from a height may suggest the possibility of a fractured calcaneus or talus bone.

Why: certain causes of foot pain may be due to unsuitable footwear.

Why: e.g. diabetes, atherosclerosis, Reiter's syndrome, Ankylosing spondylitis.

Why: certain medications that can cause spasm of the vascular supply and therefore pain including beta blockers and ergotamine.

Why: e.g. such as hands, legs, spine, sacro-iliac joints - may indicate that the foot pain is part of an arthritis condition such as Reiter's syndrome or Ankylosing Spondylitis which are both associated with plantar fasciitis and Achilles tendonitis.

Why: may suggest Reiter's syndrome which is both associated with plantar fasciitis and Achilles tendonitis.

Why: may suggest Reiter's syndrome.

Why: may suggest Ankylosing spondylitis or Reiter's disease which are both associated with plantar fasciitis and Achilles tendonitis.

Why: e.g. intermittent claudication (pain in calf and sometimes foot with exercise and relieved by rest); numbness of foot at rest or on walking; rest pain at night, interfering with sleep, precipitated by elevation and relieved by dependency of foot. Arterial ulcers due to inadequate arterial blood supply are usually very painful.

Why: e.g. pain under the heel, about 5 cm from the end of the heel when first stepping out of bed or with standing after sitting, relieved after walking about, increases towards the end of the day. It may be bilateral but is usually worse on one side.

Why: e.g. aching pain in the Achilles tendon aggravated by walking on toes. Stiff and sore in the morning after rising but improves with activity. May be caused by repeated toe running in sprinters, running uphill in distance runners or unaccustomed running or walking long distances.

Why: e.g. sudden sharp pain at the time of the injury over the Achilles tendon, sharp pain when stepping off the affected leg. Usually occurs in males over age 30 who are sporadically engaged in sport requiring jumping or running.

Why: e.g. sudden onset of intense pain over the Achilles tendon causing the person to fall down, swelling and bruising over the lower part of the Achilles tendon, some difficulty with walking, especially on tip toe.

Why: e.g. pain over the heel and most of the sole, weakness of knee flexion, hip extension, weakness of the calf and foot muscles, absent ankle jerk reflex and plantar reflex.

Why: e.g. often excruciating pain in the great toe staring in the early hours of the morning, skin over the joint may be red, shiny, swollen and hot, joint is very tender to touch. Pain may be precipitated by alcohol excess, surgical operation, starvation and certain medications. May be associated with Achilles tendonitis.