heel pain
Post on 13-May-2015
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Heel Pain and You
Causes and Treatment for a Common Foe
What is Heel Pain?• The human foot is
largely a triangle• The plantar fascia is
the base of the triangle• This supports the arch• Can be pulled, strained
and injured with activity
Plantar fascia
What is Heel Pain?• With increased load on the
foot, the fascia is stretched and inflamed
• Once inflamed, every step injures it over and over again
Causes of Heel Pain• Overuse
syndromes– Carrying heavy
loads while walking – Increased body
weight– Overstretching
activities
Causes of Heel Pain
• Trauma– Fall from a height
• Frank fracture
– Constant and repetitive load on the feet• Stress fracture
– Weight falling on the foot
Causes of Heel Pain
• Infection– Direct extension
• Stepping on sharp object
– Hematologic spread• Distal infection travels
through the blood
Causes of Heel Pain• Biomechanics
– Flatfoot condition– Tight Achilles tendons– Bunion deformities– Painful areas causing
alteration of gait– Inappropriate shoes
Causes of Heel Pain• Arthritides
– Rheumatoid arthritis – Ankylosing spondylitis (Marie-Strumpel)– Gout– Psoriatic arthritis– Systemic lupus erythematosis– Reiter’s syndrome– Enteropathic arthritides (Irritable bowel syndrome)
Causes of Heel Pain• Entrapment of nerves in the spine
(radiculopathy)• Lesion at the DRG (dorsal root ganglion)• Lesion at the peripheral nerve or terminal branch• Test by NCS (nerve conduction studies), EMG
(electromyographic studies), F wave and H reflex studies or magnetic resonance imaging
Causes of Heel Pain• Tumors of bone are a
rare but serious cause of heel pain
• Pain in the heel or fracture through the tumor may be the first sign
Treatment of Heel Pain
• Non-steroidal anti-inflammatory medications• Steroidal anti-inflammatory injections• Orthotics• Proper shoes• Stretching exercises (?)• Physical therapy
Treatment of Heel Pain (when conservative measures fail)
• ESWT • Surgery• Tarsal tunnel
release
Tarsal Tunnel Release• Entrapment of the
Posterior tibialis nerve with medial calcaneal branch to the heel
• Release is like a carpal tunnel procedure, but for the ankle
Achilles Tendinosis Pain• Due to strain of the Achilles
tendon– Possibly short Achilles
• If chronic, may cause a bone spur (Haglund’s deformity)– Never inject steroids near this– Except for heel lifts and open-back
shoes, very little conservative treatment for this
– Surgical correction of the bump and the short Achilles is best
Heel Pain (conclusions)• If you work on your feet, wearing decent shoes can help avoid
significant problems.• Once the pain presents itself, 99% of Plantar fasciitis problems
can be dealt with via conservative means (Non-steroidal anti- inflammatory therapy and Steroidal anti-inflammatory injections) and orthotic support in the shoes
• If conservative measures fail, ruling out a spinal entrapment, Tarsal tunnel syndrome or arthritides must be done before any consideration of ESWT or surgery
Thank You
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