Heel Pain

Question 1

etiology of majority of heel pain

Answer 1

mechanical heel pain

Question 2

plantar mechanical heel pain

Answer 2

plantar fasciitis (PLFS)
apophysitis

Question 3

posterior mechanical heel pain

Answer 3

achilles tendonitis
haglund’s deformity
bursitis
apophysitis

Question 4

insertional pain at attachment of plantar fascia with or without heel pain

Answer 4

plantar fasciitis

Question 5

s/s plantar fasciitis

Answer 5

• post static dyskinesia (pain upon arising in the morning or from seated position)
• pain decreases after a few steps, returns later in day
• unilateral
• no inciting incident

Question 6

Physical exam plantar fasciitis

Answer 6

• high BMI
• equinus
• pain with palpation of inferior-middle, inferior-medial or medial heel (max point is usually more medial)
• rarely edema or erythema found
• PRONATION 90% or pes cavus

Question 7

1st line tx Plantar heal Pain

Answer 7

• padding and strapping of the foot
• therapeutic orthotic insoles
• oral anti-inflammatory med
• cortisone injection
• achilles and plantar fascia stretching

Question 8

which is better for Plantar heal pain… achilles or plantar fascia stretching?

Answer 8

plantar fascia

Question 9

2nd line tx plantar fasciitis

Answer 9

• custom orthotic devices
• night splint
• repeat cortisone injections
• botulinum toxin
• Physical therapy
• cast or boot immobilization

Question 10

3rd line tx PHP

Answer 10

• endoscopic plantar fasciotomy
• extracorporal shock wave therapy
• bipolar radiofrequency

Question 11

POSTERIOR heel pain ddx

Answer 11

insertional achilles tendonapthy, enthesopathy, haglund’s, bursitis

Question 12

tx achilles tendonitis

Answer 12

• heel lifts, open back shoes
• ice
• gentle stretching until onset of pain
• NSAID
• no corticosterioids**
• PT iontophoresis
• activity modification
• immobilization w/asst or CAM

Question 13

radiographic findings for haglund’s deformity

Answer 13

• lateral view
• fowler and philip greater than 75
• total angle greater than 90
• parallel pitch lines
• prominence protrudes above superior line

Question 14

irritation of open growth plate

Answer 14

apophysitis aka sever’s disease

Question 15

baxter’s nerve

Answer 15

muscular branch to abductor digiti minimi from lateral plantar n.

Question 16

s/s nerve entrapment

Answer 16

• manifest with some sort of unilateral paresthesia or pain
• bilateral symptoms suggest systemic problem
• tinels or valleix will be positive

Question 17

FRESH EGGS for heel pain you can’t figure out

Answer 17

F - fibromyalgia
R – Rheumatoid arthritis
E – enthesopathy (pain at insertion of soft tissue into bone)
S – spine pain, sore throat, sleep disturbance
H - headaches
E – eye infection or inflammation
G – GI problems
G – GU problems
S – sores or skin abnormalities

Question 18

what are bywater lesions

Answer 18

bony prominences on calcaneus related to certain arthrities

Question 19

heel pain elicited by squeezing sides of calcaneus

Answer 19

highly suspicious calcaneal stress fractures