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Common Heel Disorders

Common Heel Disorders & heel pain relief

Plantar Fascitis (Heel Spur Syndrome)

Location of heel pain and heel pain relief

Location of heel pain

This is one of the most common problems that bring people to the foot doctor.  For complete heel pain relief you will need to visit a podiatrist.  It generally causes heel pain in the front of the heel on the inner side of the sole. Most of the time the pain is most severe in the morning or after sitting for a long period of time. This is often accompanied by tightness of the calf muscles or Achilles tendon.

Etiology

Pronation and tightness of the calf may cause microscopic tears of the plantar fascia as it stretches under the heel. The tears heel with scar tissue that becomes inflamed and inflammation causes heel pain.

Assessment

X-Rays to rule out neoplasm or tumor or fracture Lab studies such as sed rate, CBC, RF, HLA-B27, uric acid, and ANA. These test are to rule out any systemic disorders are suspected. Bone scan only use to suspect stress fracture or osteomyelitis MRI or ultrasound can also be helpful, but not generally needed for plantar fascitis.

Treatment

Many types of of way to heel pain relief:  Rest Ice Low Dye strapping NSAIDS (anti-inflammatory such as Ibuprofen, vioxx, celebrex, feldene, naprosen, Steroid injections (no more than 3 per year), heel pads or cushions, Proper shoes, massage, Stretching and physical therapy, Custom made orthotics, Over the Counter orthotics such as Spencos or Power steps, (which Dr. Timko offers and recommends this type at his office), Ultrasound, Surgery.

Haglund’s Deformity

More information coming soon. Other Systemic Disorders affecting the Heel

Rheumatoid arthritis

This is a systemic autoimmune disease that effects different joints of the body. The problem RA causes is chronic, symmetric, and erosive synovitis of the joints. It can also effect multiple organs of the body and the average age of onset is 40. Women are affected more then men.

Etiology

Unknown

Symptoms

Malaise, fatigue, low-grade fever, anorexia, weight loss Stiffness, particularly after

prolonged rest, is usually severe and last 60 minutes or more Warmth over affected joints Limitation of movement of joints Symmetry of joint involvement Rheumatoid nodules can develop over pressure points Lungs: Caplan’s syndrome, pulmonary nodules, pulmonary vasculitis and hypertension Heart: pericarditis Hematologic: anemia, Felty’s syndrome : neutropenia, splenomegaly, and RA Neurologic: Neuropathy, myelopathy caused by subluxation of cervical vertebrae Dry eyes There are 7 criteria for diagnosis of RA, patients must satisfy at least 4 of 7 to have RA.

Treatment for heel pain relief

Improve muscle tone, correct deformities or prevent deformities, physical therapy, occupational therapy Asprin, NSAIDS, Glucocorticoids DMARDS (Disease modifying AntiRheumatic Drugs) SAARDS (Slow Acting AntiRheumatic Drugs) Surgical treatment Synovectomy/tenosynovectomy Removal of rheumatoid nodules Release of joint contractures Manipulation of joints under anesthesia Patients on steroid therapy within 1 year of surgery will require a supplementation of hydrocortisione before surgery , during and after surgery to prevent sudden hypotension during surgical stress. Atlantoaxial subluxation is present in about 40-60% of patients with RA

Other causes of heel pain:

gouty arthritis

Gouty arthritis in the hands

Ankylosing spondylitis, Psoriatic arthritis, Reiter’s syndrome, Gout, Pseudogout, Behcet’s syndrome, Tumors or Neoplasms effecting the heel, Sever Disease, Calcaneal apophysitis in children aged 7-15 This is a growth plate inflammation that will go away on it’s own most of the time. Sacral Radiculopathy Calcaneus fracture (Stress or Traumatic) Atrophy of the Plantar fat pad, Tarsal Tunnel Syndrome, Neuritis or nerve entrapments, Baxter’s nerve , Medial calcaneal branch of the posterior nerve, Infection Plantar Fascia rupture

See Heel pain arthritis for more information.