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Heel Disorders
Plantar Fascitis (Heel Spur Syndrome)
This is one of the most common problems that bring people to the foot doctor. It generally causes 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 tighness 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 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
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
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:
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.
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