Heel Pain

Question 1

What are the 2 most common causes of heel pain?

Answer 1

mechanical

neurologic

Question 2

what are some causes of plantar heel pain due to poor mechanics?

Answer 2

plantar fasciitis

apophysitis

Question 3

what are some causes of posterior heel pain due to poor mechanics?

Answer 3

achilles tendonitis
Haglunds deformity
bursitis
apophysitis

Question 4

s/s of plantar fasciitis

Answer 4

• pain with the first step of the day but gradually decreases after a few steps
• usually unilateral
• no inciting event noted

Question 5

What are some tier 1 treatment options for plantar fasciitis?

Answer 5

(try for 6 wks)

• stretching exercises
• avoid barefoot, flat shoes
• oral anti-inflammatorieis
• corticosteroid injection
• OTC arch support
• padding ands trapping

Question 6

what are some tier 2 treatment options for plantar fasciitis?

Answer 6

(try for 6 months)

• night splints
• subsequent injection
• prescription orthotics
• immobilization or CAM walker
• botulinum toxin
• physical therapy

Question 7

what are some tier 3 treatment options for plantar fasciitis?

Answer 7

surgery: plantar fasciotomy +/- heel spur resection

electric shock wave tehrapy

Question 8

how long should patients possess chronic symptoms and undergo conservative treatment prior to consideration for 3rd tier treatment options for plantar fasciitis?

Answer 8

6 months

Question 9

how would you treat fat pad atrophy?

Answer 9

padding
orthotics
silicone
graft jacket

Question 10

what are some reasons for fat pad atrophy?

Answer 10

aging
steroid injection
surgery

Question 11

if heel pain is more lateral to achilles tendon, is this indicative of insertional achilles tendinopathy? or haglund’s/ bursitis?

Answer 11

haglund’s or bursitis

if pain was AT achilles tendon, this would be insertional achilles tendinopathy

Question 12

s/s of achilles tendonitis?

Answer 12

• pain at insertion of AT
• pain with ankle dorsiflexion or toe standing
• pain aggravated by increased activity, esp uphill walking

Question 13

treatment for achilles tendonitis?

Answer 13

• heel lifts
• ICE
• stretchin
• NSAIDs
• avoid corticosteroid shots**
• iontophoresis
• activity modification
• immobilization with cast or CAM walker

Question 14

what will you see on a lateral view of radiographic exam in Haglund’s deformity?

Answer 14

Fowler and Phillip angle >75 deg
total angle > 90
parallel pitch lines protrusion

Question 15

what is apophysitis?

Answer 15

irritation of open growth plate usually seen in pre-to-early adolescence

Question 16

what nerves are commonly involved in neurologic heel pain?

Answer 16

• tibial nerve
• medial calcaneal n.
• muscular br. to abductor digiti minimi (aka Baxter’s nerve)

Question 17

arthritic heel pain can be seen in which systemic arthridities?

Answer 17

seronegative diseases
Reiter's disease
psoriatic arthritis
RA
fibromyalgia
gout
diffuse idiopathic skeletal hyperostosis (DISH)

Question 18

When are Bywater’s lesions seen?

Answer 18

lateral heel views show these lesion patterns indicative of systemic arthridities