heel pain
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Etiology
- inferior
- posterior
- Achilles tendonitis or rupture
- Halund deformity 'pump bump'
- bursitis
- calcaneal apophysitis (Sever's disease) in children
- medial
Clinical manifestations
- tenderness over bone, tendon, plantar fascia, &/or soft tissue may be present
- pain with medial & lateral compression of the calcaneus (stress fracture)
- positive Tinel's sign (tarsal tunnel)
- palpable gap in Achilles tendon
- Thompson test: no plantar flexion noted on squeezing calf with rupture of Achilles tendon
- cavus or pronated foot associated with plantar fasciitis
- pain with first step on rising in the morning & after periods of rest
Laboratory
- erythrocyte sedimentation rate (ESR) or C-reactive protein (CRP) if indicated
- rheumatoid factor (RF) if indicated
Diagnostic procedures
Radiology
plain radiograph of calcaneus
Management
R: rest from pain-eliciting activities
I: ice for 20 minutes several times/day while area is swollen
C: compression with padding & a wrap
E: elevation above level of heart to reduce edema
D: non-steroidal anti-inflammatory Drugs (NSAIDs) for pain & inflammation if not contraindicated
- supportive footwear with heal support, lace-up shoes
- see plantar fasciitis
- posterior tibialis tendonitis:
- medial arch support or wedge
- physical therapy
- Haglund deformity, Achilles tendonitis or bursitis
- 1/4 inch heel wedge
- calf stretching
- physical therapy
- Achilles tendon rupture: surgical consultation
- shock wave therapy vs surgery for plantar osteophytes (spurs)[2][3]
- foot orthotics offer no advantage over other conservative treatments[5]
More general terms
Additional terms
References
- ↑ Saunders Manual of Medical Practice, Rakel (ed), WB Saunders, Philadelphia, 1996, pg 751-52
- ↑ 2.0 2.1 Journal Watch 22(9):73, 2002 Rompe JD et al, J Bone Joint Surg Am 84:335, 2002 PMID: https://www.ncbi.nlm.nih.gov/pubmed/11886900
- ↑ 3.0 3.1 Journal Watch 24(2):16-17, 2004 Gerdesmeyer L, JAMA 290:2573, 2003 PMID: https://www.ncbi.nlm.nih.gov/pubmed/14625334
- ↑ Medical Knowledge Self Assessment Program (MKSAP) 15, American College of Physicians, Philadelphia 2009
- ↑ 5.0 5.1 Rasenberg N, Riel H, Rathleff MS et al Efficacy of foot orthoses for the treatment of plantar heel pain: a systematic review and meta-analysis. British J Sports Med. 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29555795 <Internet> http://bjsm.bmj.com/content/early/2018/02/23/bjsports-2017-097892
- ↑ Diagnosis and Treatment of Heel Pain American College of Foot and Ankle Surgeons http://www.acfas.org/HealthcareCommunity/Content.aspx?id=365