Thankfully, our patient's heel in the quiz is not fractured.  A fracture is a break in a bone.  It is usually caused by trauma and shows up on x-ray as a dark line going through the white bone.

The x-ray to the right is an example of a fractured calcaneus (heel bone).  The white arrowheads indicate the margins of the dark fracture line through the body of the calcaneus.

Sorry, bunions do not directly cause heel pain.  Also, the x-ray shown in the question did not show a bunion.

Bunions (hallux valgus) affect the great toe of the foot.  They can be hereditary in nature, but other factors, like choice of footwear, can certainly contribute to bunions as well.

Severe bunion deformities can become very painful and require surgery.  However, mild to moderate cases of bunions, often respond really well to custom orthotics.

> Correct.

Congratulations!  If you chose plantar fasciitis, you are right.

Plantar fasciitis is a painful condition of the foot and arch.  It characteristically produces a sharp pain with stepping out of bed first thing in the morning.  It can also be painful with walking.

The clue in this x-ray, that should have led you to your diagnosis, was the presence of a heel spur.  Heel spurs form in response to long-standing tension on the plantar fascia.

The plantar fascia is a broad, thick tendon-like tissue that helps support the arch of your foot.  It inserts into your heel bone (calcaneus).  In plantar fasciitis, the fascia is injured and inflammed.  A vicious cycle of microscopic-tearing and healing of the fascia leads to pain with stepping out of bed in the morning.

Dr. Nyman has a high success rate in treating plantar fasciitis.  Ultrasound, advanced soft-tissue therapy, stretches, ice and custom orthotics can all be helpful in treating this painful condition.

Gout can affect the heel but it more commonly affects the big toe.  The x-ray to the right shows a chronic gouty arthritis with significant soft tissue swelling and evidence of erosion into the bone.

Gout is an acute arthritis of the peripheral joints.  It results from deposition of monosodium urate crystals in and about the joints and tendons of the feet and hands.

Bursitis is inflammation of a bursa.  A bursa is a fluid filled sac that acts as an anti-friction device between a bone and a tendon.

You can get bursitis at your heel, but not on the bottom of your foot.  It usually happens closer to the insertion of the Achilles tendon into your heel.  You can  not see bursitis on x-ray unless it has been there for a long time and the bursa has become calcified.  The x-ray in our question does not show a calcified bursa.

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