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Technique for determining when plantar heel pain can be neural in origin.
Dellon AL.
Microsurgery. 2008 Jul 11. [Epub ahead of print]

 

If you ask your patient if there is "burning, shooting, or tingling" on the history, or if you ellicit a positive Tinel's sign on palpation of the first or second branch of the medial calcaneal nerve, then you can be sure that the pain is neural in origin locally.

 

I agree with the paper that is quoted. I find, however, the compressive neuropathy is a later stage of the condition. In other words, the patient first develops post static dyskinesia. Secondly, the patient develops pain on walking at the end of the day which progresses to earlier in the day. Finally the patient develops entrapment neuropathy.

 

Well that would make sence as oedema consistent with chronic inflammation of teh area entraps the first lateral brance of the medial calcaneal nerve as it passes under the plantar fascia near the insertion. Often found these to be the most difficult to treat, even with orthoses, taping physical therapies and camm walkers.

 

Prevalence for plantar fasciitis of neural origin in community-dwelling adults
Hetakshi Dhananjay Thakar et al
DOI: 10.4103/mjdrdypu.mjdrdypu_501_20