INTRODUCTION:

CVT One in ten people will experience inferior heel pain at some point in their lives, along with plantar heel pain, which is a frequent ailment in the general population. There are several contributing factors to heel discomfort. Plantar fasciitis is the most typical cause of heel discomfort in adults. It can be difficult for orthopaedic specialists to accurately identify and treat plantar fasciitis, a common pathological ailment that affects the back foot. It is an overuse injury that causes swelling at the plantar fascia's origin and nearby perifascial components, including the calcaneal periosteum. In adults, it is the clinical issue that most frequently results in inferomedial heel discomfort. Lapidus and Guidotti discovered that more patients with plantar fasciitis than any other foot disease had visited their foot clinic¹.

Plantar fasciitis is commonly regarded as an overuse condition among athletes, particularly runners (it accounts for roughly 10% of all running injuries), however, it also occurs in the general population. Plantar fasciitis is commonly thought to be caused by abnormal foot biomechanics and/or foot types, incorrect footwear, and obesity. Foot over-pronation is thought to increase strain on the plantar soft tissues, increasing the risk of injury². The plantar fascia's main job is to stabilize the mid-foot and support the medial longitudinal arch while the foot is loaded statically and dynamically. Additionally, it helps the heel pad absorb dynamic shock ³. Due to its function in preserving the medial longitudinal arch and the strain imposed by the heel's shock-absorbing properties, the plantar fascia is vulnerable to recurrent damage at the posterior insertion. The actual damage is an enthesopathy (an anomaly or injury at the point of attachment of a ligament or tendon to bone) at the medial tubercle of the calcaneus, where the plantar fascia originates. This condition is brought on by excessive traction and is frequently accompanied by discomfort while taking the first step in the morning⁴.

Most experts agree that plantar fasciitis results from persistent inflammation and recurrent partial tears at this enthesis. The recurrent traction produced on the plantar fascia while walking or running may result in micro- and macro-tears, which trigger a reparative inflammatory response if there is a predisposing or exacerbating condition. The persistent stress brought on by carrying weight interrupts the healing process, leading to chronic degenerative alterations⁵. Thesemodifications include collagen necrosis, angiofibroblastic hyperplasia, chondroid metaplasia, and mucinoid or fibrous degeneration matrix calcification. Prolonged inflammatory alterations in the tissue manifest initially as edema and subsequently as thickening of the plantar fascia. The pathologic characteristics that cause any patient's symptoms are unknown. However, it is claimed that the ordinarily robust fascia stiffens and becomes more prone to reinjury, creating a vicious loop of chronic pain. Furthermore, plantar fascia thickening, reduced vascularity, peri tendinous inflammation, and changes in nociceptor physiology may all play a role in the onset and duration of heel pain⁶.

The Achilles tendon is tight in most people with plantar fasciitis. Furthermore, research has shown that pain causes plantar fascia to shrink. During locomotion, a tight Achilles tendon or constricted plantar fascia exerts additional strain on the inflammatory tissue. It is unusual to have a patient with plantar fasciitis arrive immediately after experiencing discomfort⁷. Most patients arrive after attempting various home treatments and suffering from weeks to months of continuous low to high-grade pain. Approximately 95% of those with plantar fasciitis will have their symptoms resolved between six to eighteen months⁸. Although plantar fasciitis is the most prevalent cause of heel pain, several different etiologies are usually linked with heel pain and are sometimes misinterpreted as plantar fasciitis⁹.

Plantar heel pain is a frequent disease in adults; it can escalate to severe discomfort, causing substantial disability and impairment of everyday activities¹⁰. A thorough history and physical examination are essential for accurate diagnosis¹¹. The posterior tibial nerve in the tarsal tunnel, which is located behind the flexor retinaculum and below the medial malleolus, is compressed in tarsal tunnel syndrome. Burning or tingling pain that radiates to the foot is one of its symptoms. This pain is typically made worse by walking and becomes worse during the day. Before beginning any treatment, the heel pain's underlying cause must be identified to ensure success. Otherwise, it's possible to misdiagnose the condition and give the patient the incorrect medications, which won't help their condition ¹².

Anti-inflammatory drugs are regularly used to treat pain and speed up the tissues' natural healing process. Several physical treatments, including iontophoresis, phonophoresis, ultrasound, laser, cryotherapy, and hydrotherapy have been touted as beneficial in the management of plantar fasciitis in addition to prescription drugs. Although all these techniques have been advocated for the treatment of pain and inflammation, no research has been done on individuals with plantar fasciitis to ascertain the real efficacy of these techniques.¹³ The diagnosis of plantar fasciitis, heel fat pad atrophy, and entrapment neuropathies is confirmed by high-resolution ultrasonography¹⁴. Examining the neurogenic origins of plantar heel pain necessitates electrophysiological research. In addition to being able to identify soft tissue abnormalities, magnetic resonance imaging may also be superior to ultrasound for examining bone problems. Non-steroidal anti-inflammatory medicines (NSAIDs), rehabilitative measures, local injections, and surgery are among the available treatments. In conclusion, "Heel Pain" refers to a variety of illnesses that may be misdiagnosed as Plantar Fasciitis and treated as such. This study's goal is to assess the effectiveness of using clinical techniques and diagnostic injections to distinguish between neuropathic and inflammatory heel pain.¹⁵

Plantar fasciitis (PF), according to Karim Gariani et al., is a prevalent degenerative illness and a prominent source of heel discomfort, primarily affecting people in their fourth and fifth decades. Diabetes patients are more vulnerable owing to the existence of frequent hazards and co-morbidities like obesity or a sedentary lifestyle. Most PF diagnoses are clinical. Imaging is not suggested as a first step. Conservative treatment should begin with physiotherapy, off-loading, stretching exercises, and nonsteroidal anti-inflammatory medicines. In recalcitrant situations, glucocorticoid injections or surgery may be considered later. Although the specifics may change, the overall therapy of PF does not differ between diabetic and non-diabetic individuals. The current level of knowledge about the risk factors, pathogenesis, diagnosis, assessment, and therapy of PF in diabetic individuals is summarized in this narrative review¹⁶. According to L. Daniel Latt et al., plantar fasciitis is the most typical adult-related cause of persistent heel pain, afflicting both younger patients who are active and older patients who are sedentary. Point soreness at the plantar fascia's origin on the medial tubercle of the calcaneus serves as a confirmation of the diagnosis. A gastrocnemius and plantar fascia stretch, anti-inflammatory medicine, activity moderation, and an in-shoe orthosis that elevates and cushions the heel are the initial treatments. Gastrocnemius recession, medial head of gastrocnemius release and partial plantar fasciotomy are examples of surgical procedures that relieve pressure on the plantar fascia and promote recovery¹⁷.

Andrea Bernetti and colleagues’ Neuropathic pain is caused by an injury or illness of the central and/or peripheral somatosensory nerve systems, and it has a substantial impact on quality of life, particularly because it is frequently resistant to therapy. Rehabilitative intervention is included in numerous neuropathic pain treatment recommendations, but not organically or thoroughly. The purpose of this systematic review was to examine the most often-used therapy modalities and provide rehabilitation recommendations for the treatment of neuropathic pain. PRISMA criteria were used for conducting the systematic review. The scientific inquiry, which lasted through July 2020, looked at English-language standards from the previous thirteen years. Six recommendations were examined, and it was determined that neuropathic pain therapy should be driven by a multidisciplinary strategy that includes both pharmacologic and non-pharmacologic approaches. Rehabilitation, via an appropriately designed rehabilitation program and physical treatments, plays an important role in non-pharmacological intervention. It emphasizes the significance of rehabilitation while also highlighting the scarcity of data on various rehabilitative approaches. As a result, further research in this sector is required to properly identify a rehabilitative therapy method¹⁸.

MATERIALS AND METHODS:

(a) Design: Plantar fasciitis is the most prevalent cause of persistent heel pain in adults, affecting both active young people and elderly inactive people. It is caused by recurrent stress on the plantar fascia at its origin on the calcaneus's medial tubercle, and it is frequently coupled with gastrocnemius tightness. A focused history and physical examination can be utilized to make the diagnosis; imaging is reserved for unusual presentations and those that do not respond to first therapy. To distinguish between neuropathic and inflammatory heel pain. To assess the utility of clinical approaches for distinguishing between neuropathic and inflammatory heel pain. To assess the use of Sural nerve ankle block as a diagnostic tool for distinguishing between.

(b) Sample and Instruments: This is hospital-based prospective research (analytical study) that lasted 18 months beginning in December 2018. The study was carried out in the Department of Orthopedics OPD, Krishna Institute of Medical Sciences University, Karad, after ethics committee permission. Patients were informed about the surgery as well as any potential problems. Each patient provided written informed consent. The sample size determined by the formula was 50.

(c) Data Collection: The current study examined the use of clinical techniques and diagnostic injection to discriminate between neuropathic and inflammatory heel pain in 40 patients who complained of heel discomfort. The study's findings includes that after reviewing clinical examination and a diagnostic Sural nerve block, 31 (77.5%) of the 40 instances of heel pain were identified as inflammatory heel pain and 9 (22.5%) as neuropathic heel pain. The following tables show a comparison of both types of heel discomfort.

Table 1: The age (years) distribution of the research participants

Age	Neuropathic Pain	Inflammatory Pain	Total
<40 years	2(22.2%)	4(12.9%)	6(15%)
40-50 years	1(11.1%)	7(22.6%)	8(20%)
50-60 years	2(22.2%)	8(25.8%)	10(25%)
60-70 years	3(33.3%)	10(32.3%)	13(32.5%)
>70 years	1(11.1%)	2(6.5%)	3(7.5%)
Total	9(100%)	31(100%)	40(100%)
Age(mean±SD)	54±12.4	56.3±15.8	55.4±14.6

P value 0.716 (unpaired t-test)

The age distribution of study cases is shown in the Table 1. The age group 60 to 70 years had the highest number of cases (32.5%), followed by 50 to 60 years. The average age of the patients was 55.4 years. The mean age of cases diagnosed with Neuropathic heel Pain was 54.2 years, whereas those identified with inflammatory heel Pain were 56.3 years. The difference in mean age was statistically insignificant (p >0.05), indicating that there was no difference in mean age between the two groups.

Table 2: Distribution ofstudy cases by sex

Sex	Neuropathic Pain	Inflammatory Pain	Total
Male	4 (44.4%)	12 (38.7%)	16 (40%)
Female	5 (55.6%)	19 (61.3%)	19 (61.3%)
Total	9 (100%)	31 (100%)	40 (100%)

P value 0.757 (Chi-square test)

According to the data above, 60% of the patients were female. Table 2 shows that there was no significant difference in gender distribution among subjects diagnosed with neuropathic or inflammatory heel pain (p>0.05).

Table 3: Distribution of study cases by occupation

Occupation	Neuropathic Pain	Inflammatory Pain	Total
Farmer	4 (44.4%)	11 (35.5%)	15 (37.5%)
Housewife	3 (33.3%)	16 (51.6%)	19 (47.5%)
Clerical Work	1 (11.1%)	3 (9.7%)	4 (10%)
Business	1 (11.1%)	1 (3.2%)	2 (5%)
Total	9 (100%)	31 (100%)	40 (100%)

P value 0.6773 (Chi-square test)

The distribution of the study cases, by occupation, is shown in the Table 3. Farmers (37.5%) and housewives (47.5%) had the highest percentage of cases. The occupation distribution of study subjects with either inflammatory heel pain or neuropathic heel pain was not significantly different from zero (p>0.05).

Table 4: Cases distributed based on the kind of heel pain.

History of type of Pain	Neuropathic Pain	Inflammatory Pain	Total
Sharp /stabbing	2 (22.2%)	31 (100%)	33 (82.5%)
Burning/tingling	5 (55.6%)	0 (0%)	5 (12.5%)
Sharp and burning/tingling	2 (22.2%)	0 (0%)	2 (5%)
Total	2 (5%)	31 (100%)	40 (100%)

P value <0.001 (Chi-square test)

The distribution of study cases by kind of pain is shown in the Table 4. Sharp/stabbing pain accounted for the greatest percentage of instances (82.5%), followed by burning pain (12.5%). In two cases, the pain was piercing and scorching. More than half of patients with neuropathic pain have burning heel pain, compared to all instances of inflammatory heel pain, which all experienced acute pain. There were instances of neuropathic heel pain that showed considerably higher burning pain (p<0.01).

Table 5: Distribution of instances by the "worst time of day for pain"

Time of day pain is the worst	Neuropathic Pain	Inflammatory Pain	Total
Persistent throughout the day	7 (77.8%)	3 (9.7%)	10 (25%)
Morning	0 (0%)	28 (90.3%)	28 (70%)
Evening	2 (22.2%)	0 (0%)	2 (5%)
Total	9 (100%)	31 (100%)	40 (100%)

P value <0.001 (Chi-square test)

The distribution of study cases according to the hour of the day when the pain was the worst is shown in the Table 5. The majority of cases (70%) had pain in the morning, followed by 10 cases in which the pain persisted all day. 90% of instances with inflammatory heel pain had their greatest discomfort in the morning, compared to 77.8% of cases of neuropathic pain, which had ongoing pain all day. The persistent pain was substantially more common in neuropathic pain, but morning pain was significantly more common in inflammatory cases (p<0.01).

Table 6: Distribution of instances according to pain intensity

Duration of pain in a single day	Neuropathic Pain	Inflammatory Pain	Total
3 hours or less	1 (11.1%)	21 (67.7%)	22 (55%)
3-6 hours	3 (33.3%)	7 (22.6%)	10 (25%)
6-9 hours	5 (55.6%)	2 (6.5%)	7 (17.5%)
> 9 hours	0 (0%)	1 (3.2%)	1 (2.5%)
Total	9 (100%)	31 (100%)	40 (100%)

P value 0.002 (Chi-square test)

The distribution of study cases according to the length of daytime discomfort is shown in the Table 6. In more than half of the instances, the discomfort subsided after three hours. Pain lasting more than six hours occurred in just 20% of instances. More than half (55.6%) of instances with neuropathic pain had pain lasting from 6 to 9 hours per day, compared to 67.7% of cases of inflammatory heel pain, which had pain lasting less than 3 hours per day. As demonstrated, neuropathic heel pain subjects had substantially longer daily pain durations than inflammatory heel pain cases (p <0.01).

Table 7: Cases are distributed based on the existence of co-morbidities

Co-morbidities	Neuropathic Pain	Inflammatory Pain	Total	P value*
Diabetes	2 (22.2%)	3 (9.7%)	5 (12.5%)	0.202
Hypertension	2 (22.2%)	4 (12.9%)	6 (15%)	0.311
Other Chronic Conditions	1 (11.1%)	2 (6.5%)	3 (7.5%)	0.436
No co-morbidities	4 (44.4%)	22 (71%)	26 (65%)	Ref
Total	9 (100%)	31 (100%)	40 (100%)

P value calculated by chi-square and by comparing the study variable with ‘No co-morbidities.The distribution of study cases across different co-morbidities is seen in the Table 7. Out of a total of 40 patients, 15% had hypertension, 12.5% had diabetes, and 7.5% had other co-morbidities. Application of statistical analysis revealed that there was no appreciable difference in the prevalence of any co-morbidities between the cases with neuropathic and inflammatory heel pain.

Table 8: The distribution ofstudy cases by side of heel pain

Side of heel pain	Neuropathic Pain	Inflammatory Pain	Total
Right only	5 (55.6%)	4 (12.9%)	9 (22.5%)
Left only	4 (44.4%)	6 (19.4%)	10 (25%)
Bilateral	0 (0%	19 (61.3%)	19 (47.5%)
Total	9 (100%)	29 (93.5%)	38 (95%)

P value 0.002 (Chi-square test):

The distribution of study cases by side of heel pain is shown in the Table 8. Bilateral heel pain was present in nearly half of the instances (47.5%). While all instances of neuropathic pain had unilateral heel pain, 61.3% of cases with inflammatory heel pain had bilateral heel pain. This difference was statistically significant (p <0.01), showing that instances of inflammatory heel pain had considerably greater bilateral discomfort.

Table 9: Cases distributed based on the location of the tenderness

Location of tenderness at heeland foot	Neuropathic Pain	Neuropathic Pain	Total
Plantar only	0 (0%)	22 (71%)	22 (55%)
Medial only	2 (22.2%)	1 (3.2%)	3 (7.5%)
Lateral only	2 (22.2%)	0 (0%)	2 (5%)
Plantar + Medial	3 (33.3%)	8 (25.8%)	11 (27.5%)
Plantar + Medial	2 (22.2%)	8 (25.8%)	2 (5%)
Total	9 (100%)	31 (100%)	40 (100%)

P value <0.001 (chi-square test applied)

The distribution of study cases according to the site of soreness near the heel and foot, Table 8. Discomfort was seen in more than half (55%) of patients, with another 27.5% exhibiting both plantar and medial side discomfort. In instances with inflammatory heel pain, 71% of patients only exhibited plantar side discomfort, while another 25.8% had both plantar and medial side tenderness. None of the instances with neuropathic heel pain had just plantar side soreness. There are examples of lateral and medial side alone soreness, as well as a planter with medial and lateral side tenderness. According to Table 9, neuropathic pain affects the plantar side substantially less than inflammatory pain, a statistically significant difference (p <0.01) in favor of the latter.

Table 10: Case distribution based on gore’s sign findings

Gore’s sign	Neuropathic Pain	Inflammatory Pain	Total
Positive	9(100%)	0(0%)	9(22.5%)
Negative	0(0%)	31(77.5%)	31(77.5%)
Total	9(100%)	31(100%)	40(100%)

P value <0.001 (chi-square test applied)

The Table 10 shows the distribution of study cases based on Gore's sign. 31 (77.5%) of the 40 instances had a negative Gore sign. In cases of inflammatory heel pain, all 31 patients tested negative for Gore's sign, but all 9 (55.6%) cases tested positive for neuropathic pain. This difference was statistically significant (p <0.01), showing that the chance of a positive Gore's sign is much higher in cases with neuropathic heel pain.

Table 11: Distribution ofcases based on pain intensity at a week's worth of follow-up

Pain Severity based on VAS Score	Neuropathic Pain Cases	Inflammatory Pain Cases	All cases at one-week follow-up
No pain(0)	3	0	3
Mild pain(<4)	5	2	7
Moderate pain (4-6)	1	11	12
Sever pain (≥7)	0	18	18
Total	9	31	40

P value (chi-square) <0.001

The post-block effect on pain intensity after one week, as measured by the Visual Analog Scale (VAS), is shown in the table above. After one-week, neuropathic subjects experienced much less pain than inflammatory cases (p 0.001) as indicated in Table 11.

(d) Data Analysis: The goal of the current study, which involved 40 cases of heel pain complaints, was to assess the effectiveness of using clinical techniques and diagnostic injections to distinguish between neuropathic and inflammatory heel pain. Following are some study findings:Following an evaluation of clinical techniques and diagnostic injection, out of 40 cases of heel pain, 31 (77.5%) cases were determined to be inflammatory heel pain and 9 (22.5%) cases were determined to be neuropathic heel pain. Ages 60 to 70 accounted for the highest percentage of cases (32.5%). then 50–60 years. The patients were on average 55.4 years old. The patients were on average 55.4 years old. The mean age of patients identified with neuropathic heel pain was 54.2 years, compared to 56.3 years for those diagnosed with inflammatory heel pain. The statistically insignificant difference in mean age (p > 0.05) indicates that there was no difference in mean age between the two groups. 60% of the instances were involving women. In patients identified as having either neuropathic heel pain or inflammatory heel pain, there was no statistically significant difference in the distribution of gender (p>0.05).

Farmers (37.5%) and housewives (47.5%) had the highest percentage of cases. The research patients classified as either having inflammatory heel pain or neuropathic heel pain did not significantly differ in terms of occupation (p>0.05). Sharp/stabbing pain accounted for the greatest percentage of instances (82.5%), followed by burning pain (12.5%). In two cases, the pain was piercing and scorching. More than half of patients with neuropathic pain have burning heel pain, compared to all instances of inflammatory heel pain, which all experienced acute pain. In situations of neuropathic heel pain, burning pain is substantially more common (p< 0.01). The majority of cases (70%) had pain in the morning, followed by 10 cases in which the pain persisted all day. 90% of instances with inflammatory heel pain had their greatest discomfort in the morning, compared to 77.8% of cases of neuropathic pain, which had ongoing pain all day. In contrast to the morning worst pain, which is much more common in inflammatory cases, persistent pain is significantly more common in neuropathic pain (p <0.01). In more than half of the instances, the discomfort subsided after three hours. Pain lasting longer than six hours occurred in just 20% of instances. More than half (55.6%) of instances with neuropathic pain had pain lasting from 6 to 9 hours per day, compared to 67.7% of cases of inflammatory heel pain, which had pain lasting less than 3 hours per day. When compared to cases of inflammatory heel pain, neuropathic heel pain sufferers had substantially longer daily pain durations (p 0.01). Out of a total of 40 patients, 15% had hypertension, 12.5% had diabetes, and 7.5% had other co-morbidities. The results of a statistical test showed that there was no discernible difference between instances of neuropathic and cases of inflammatory heel pain in the incidence of any co-morbidities. Bilateral heel pain was present in nearly half of the instances (47.5%). While all instances of neuropathic pain had unilateral heel pain, 61.3% of cases with inflammatory heel pain had bilateral heel pain. This difference was statistically significant (p <0.01) and showed that instances with inflammatory heel pain had considerably greater bilateral discomfort.

RESULTS AND DISCUSSION:

A relatively prevalent foot condition is heel discomfort. It goes by several names, including plantar fasciitis, jogger's heel, tennis heals, and policeman's heel. The most typical cause of heel discomfort is mechanical. Plantar fasciitis, heel spur, Sever's disease, heel bump, Achilles tendinopathy, heel neuritis, and heel bursitis are common causes of hell pain. Clinical examination is the primary foundation for the diagnosis. The absence of accompanying symptoms that would indicate a systemic illness and the location of the pain often strongly imply a diagnosis. Rest, physical therapy, stretching, changing footwear, arch supports, orthotics, night splints, anti-inflammatory medications, and surgery are all options. Almost all patient’s respond to nonsurgical conservative treatments. If all other therapies have failed, surgery is the last resort. The goal of this study was to distinguish between neuropathic and inflammatory heel pain¹⁹.

The mean age of cases identified with Neuropathic heel Pain in the current research was 54.2 years, whereas cases diagnosed with inflammatory heel Pain were 56.3 years. The difference in mean age was statistically insignificant (p >0.05), indicating that the mean age was the same in both groups. Heel pain has long been known as a common problem in the elderly population, affecting around one-third of those over the age of 65. Foot discomfort relates to a decreased capacity to handle daily tasks, issues with the imbalance and walking pattern, and an increased risk of falling in the elderly130,131 and 132. Also, as a person ages, the pads that cushion the heel from harm, such as those found under a carpet, might wear away and cease to offer shock absorption. Heel discomfort is more frequent in adults over the age of 40 who are physically active. This increased occurrence may be due to a loss in plantar fascia suppleness and a slowdown of the healing process with age.

In the current study, 60% of the patients were female. There was no statistically significant variation in gender distribution among cases diagnosed with neuropathic or inflammatory heel pain (p>0.05). Housewives (47.5%) had the most instances in the current research, followed by farmers (37.5%). There was no statistically significant difference in the occupation distribution of study subjects diagnosed with either inflammatory or neuropathic heel pain (p>0.05). Often, occupations that require lengthy periods of standing have the greatest risk of developing discomfort and heel problems. Running and leaping can place a continual strain on the heel, numerous muscles, and ligaments across the foot, ankle, and calf, resulting in substantial tissue damage. Other risk factors for this disorder include poor muscular flexibility, increased foot pronation, and leg-length disparity. Males are more prevalent than females. Flat foot issues can harm the heels of the feet, causing damage and severe discomfort. Heel discomfort is frequent in pregnant women because as the pregnancy proceeds, weight growth occur, putting more strain on the heel.The majority of people with PF have a self-limiting illness. A focused history and physical examination are performed in the evaluation. Diagnostic imaging using weight-bearing radiographs is routinely performed, and MRI or ultrasound is used for unusual presentations or instances that are resistant to first therapy. If symptoms continue after 6 months of conservative therapy, surgery or minimally invasive procedures may be explored ^20.

CONCLUSION:

Plantar fasciitis is the most prevalent cause of persistent heel pain in adults, affecting both active young people and elderly inactive people. It is caused by recurrent stress on the plantar fascia at its origin on the calcaneus's medial tubercle, and it is frequently coupled with gastrocnemius tightness. The most typical presenting symptom is agonizing plantar heel discomfort, which worsens with the first step of the day or after periods of rest. Gender, age, employment, and comorbidities have little bearing on whether a person has neuropathic or inflammatory heel pain. Positive history findings, such as the kind of heel pain, duration of heel pain, and time of day pain is worse, can help distinguish between neuropathic and inflammatory heel pain. Despite its high specificity, the Windlass test's limited sensitivity may restrict its utility in clinical assessment. Clinical indicators such as Gore's sign might suggest the existence of radiculopathy, which can mimic inflammatory heel pain symptoms. A proper clinical assessment of heel pain is essential in distinguishing between neuropathic and inflammatory heel pain. This study was the first of its kind and was not previously conducted. Additionally, because the sample size and number of cases performed in this study were smaller, it is inconclusive whether Sural nerve block can be used to distinguish between Neuropathic and Inflammatory heel pain. This would require a study with a larger sample size and more patients who would be willing to undergo the procedure.

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Received on 08.02.2024 Modified on 24.03.2024

Research J. Pharm. and Tech 2024; 17(5):1938-1944.

DOI: 10.52711/0974-360X.2024.00307

Pradeep N. Kulkarni1*, Dhaval Mukesh Tailor1, Mahendra Alate1, Kumari Lipi2, Sudhir Patil3

Pradeep N. Kulkarni¹*, Dhaval Mukesh Tailor¹, Mahendra Alate¹, Kumari Lipi², Sudhir Patil³