Prevention and Treatment of Rearfoot Injuries

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Heel pain is typically caused by stress to the structures that attach to the heel bone, the most common cause of heel pain is plantar fasciitis. This is characterized by inflammation and perhaps thickening of the plantar fascia which is a band of fibrous connective tissue running along the bottom of the foot from the hell to the ball. This is considered a chronic injury because your plantar fascia is continuously stretched past its normal extensions, causing tears in the fibers. An unstable arch causes strain in the plantar fascia caused by improperly fitting shoes, or when the Achilles tendon is too tight and puts strain on the arch and biomechanical errors. Symptoms may include pain on under or along the side of the heel and its worse first thing in the morning. Typically the pain dissipates as the foot gets warmed up but will begin to get worse as activity continues. Treatment options should focus on returning stability to the arch of your foot, and may include a change in foot wear with a slight elevated heel and stiffness in the shank portion of your foot. Over the counter arch supports can be helpful in early stages of plantar fasciistis, but often a custom corrective foot orthotic will be more effective to facilitate healing and prevent from reoccurrence. Treatment options to relieve symptoms are rest, taping, cold therapy using ice packs, deep tissue massage, and NSAID’s and stretching. A plantar fasciitis night splint is worn overnight and gently stretches the calf muscles and plantar fascia prevents tightening up of muscles. In more severe cases, cortisone injections, shock wave therapy and surgery may be required.

Another common cause of heel pain is Achilles tendonitis, causing pain at the back of the heel. This condition occurs when this tendon running along the calf, behind the ankle connecting to the back of the heel is strained causing tears along the way. The result is pain, inflammation and possibly a bony growth on the underside or back of the surface of the heel bone. This is known, as an insertional calcification of the Achilles tendon where occasional lumps develop on the back of the heel. Treatment options include: rest, cold therapy using ice baths, temporarily wearing a heel lift, NSAID’s and taping the back of the calf to support the tendon and reduce tightening. In more severe cases, ultrasound treatment is beneficial. Early recognition is key to fast healing, do not ignore morning heel pain and work with your podiatrist to develop the best treatment for you.

Tarsal tunnel syndrome is more common in active adults, the burning and tingling sensation this causes is the result of a compressed tibial nerve. Other symptoms may include numbness and shooting pain along the bottom of the foot or inside of the ankle that may extend to the heel, arch, toes and even the calf. These symptoms are initiated and aggravated by overuse of the foot including prolonged walking, standing, exercising for extended periods of time or starting out a new exercise program. Early detection and treatment is very important in order to avoid permanent nerve damage. In athletes this condition is the result of an ankle sprain, ganglion cyst, an arthritic bone spur or a fallen arch. Conservative treatments such as arch supports and wider shoes may successfully relieve the discomfort caused by the tarsal tunnel syndrome. Steroid injections may prove effective, and this is caused by flat feet, custom orthotics can help restore the foot’s natural arch. If surgical treatment is necessary, you podiatric surgeon will cut the licianiate ligament providing room. If a cyst is impinging on the nerve, it will be removed.

The os trigonum is an extra bone that forms behind the ankle bone and is present at birth, most people do not even know it’s there, until it gets caught in the ankle preventing normal movement. Os trigonum syndrome is triggered by an injury such as an ankle sprain, and repeated downward pointing of the toes. The signs and symptoms include: deep, aching pain in the back of the ankle when walking or pointing your toes downward, tenderness in the area when touched, swelling in the back of the ankle and decreased range of motion. Your podiatrist will treat you with a conservative treatment mentioned before or surgery to remove the Os trigonum.

Calcaneal apophysitis also known as Severs disease is the most common cause of heel pain in young athletes. This is a painful inflammation of the growth plate caused by overuse of your foot with repetitive heel strikes, and may also occur due to shoes with poor heel padding, poor arch supports and tight lower calf muscles. Signs and symptoms include heel pain on one or both sides when running, walking, or jumping and a visible limp. If present your activity should be modify. Your podiatrist may also recommend heel pads as a temporary relief while doing the activity.
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