Heel Pain

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Heel Pain

  1. 1. Heel Pain and You Causes and Treatment for a Common Foe
  2. 2. 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
  3. 3. 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
  4. 4. Causes of Heel Pain • Overuse syndromes – Carrying heavy loads while walking – Increased body weight – Overstretching activities
  5. 5. 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
  6. 6. Causes of Heel Pain • Infection – Direct extension • Stepping on sharp object – Hematologic spread • Distal infection travels through the blood
  7. 7. Causes of Heel Pain • Biomechanics – Flatfoot condition – Tight Achilles tendons – Bunion deformities – Painful areas causing alteration of gait – Inappropriate shoes
  8. 8. 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)
  9. 9. 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
  10. 10. 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
  11. 11. Treatment of Heel Pain • Non-steroidal anti-inflammatory medications • Steroidal anti-inflammatory injections • Orthotics • Proper shoes • Stretching exercises (?) • Physical therapy
  12. 12. Treatment of Heel Pain (when conservative measures fail) • ESWT • Surgery • Tarsal tunnel release
  13. 13. 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
  14. 14. 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
  15. 15. 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
  16. 16. Thank You

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