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Plantar fasciitis sucks. It feels like you have needles underneath your feet while you’re playing.

Joakim Noah, NBA Chicago Bulls, 2013

Injuries to the foot, both acute and chronic, can be extremely challenging for the clinician, largely due to the complex anatomy (Figs 43.1 and 43.2). If the foot is considered in its three distinct regions (Fig. 43.1)—the rearfoot (calcaneus and talus), the midfoot (the navicular proximally and medially, the cuboid laterally, and the cuneiforms distally and medially), and the forefoot (the metatarsals and phalanges)—the bony anatomy is greatly simplified. Soft tissue anatomy can then be superimposed on the regional division of the foot (Figs 43.2ce).

Figure 43.1

The regions of the foot: rearfoot, midfoot and forefoot

Figure 43.2

Anatomy of the foot (a) Lateral view of the bones of the foot (b) Medial view of the bones of the foot (c) Dorsal view of the soft tissues of the foot (d) Plantar view of the soft tissues of the foot: first layer (e) Plantar fascia

In this chapter we will consider the three different clinical presentations:

  • rearfoot pain (mainly the heel)

  • midfoot pain

  • forefoot pain.


The most common cause of rearfoot (inferior heel) pain is plantar fasciopathy/fasciitis, often mistakenly referred to as ‘heel spur’. This condition occurs mainly in runners and the older adults, and may be associated with a biomechanical abnormality, such as excessive pronation or supination.1 Another common cause of heel pain is fat pad syndrome or fat pad contusion. This is also known as a ‘bruised heel’ or a ‘stone bruise’.

Less common causes of heel pain are stress fracture of the calcaneus and conditions that refer pain to this area such as tarsal tunnel syndrome or medial calcaneal nerve entrapment (Chapter 42). Causes of rearfoot pain are listed in Table 43.1.

Table 43.1

Causes of rearfoot and inferior heel pain


The pain of plantar fasciopathy is usually of insidious onset, whereas fat pad damage may occur either as a result of a single traumatic episode (e.g. jumping from a height onto the ...

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