HEEL PAIN
Plantar fascitis is an enthesitis at the insertion of the tendon into the calcaneum .It produces localized pain when standing and walking ,and tenderness in the mid line.It occurs alone or in seronegative spondarthritis.
Plantar spurs are traction lesions at the insertion of the plantar fascia in older people and are usually asymptomatic.They become painful after trauma.
Calcaneal bursitis is a pressure - induced ( adventitious ) bursa that produces diffuse pain and tenderness under the heel.Compression of the heel pad from the sides is painful ,which distinguishes it from plantar fascia pain.
Whatever the cause ,the pain is always worse in the morning as soon as weight is placed on the foot.
All of these lesions are treated with heel pads ,and reduce walking ,these are often self-limiting .A splint at night to hold the foot dorsiflexed and to stretch the plantar fascia is preferable to a local corticosteroid injection in plantar fasciitis . When an injection is necessary , a medial approach is used ,rather than through the heel pad ,under a posterior tibial nerve block.
Heel pain causes
-Plantar fascitis ___ below heel.
-Plantar spur ___ below
-Achilles tendonitis / bursitis ___behind heel.
-Sever's disease.
Arthritis of ankle / subtaloid joints.
PAIN BEHIND THE HEEL AND LEG
Sever's disease is a traction apophysitis of the Achilles tendon in young people ( cf.Osgood -Schlatter's disease) .
Achilles tendonitis is an enthesitis at the insertion of the tendon into the calcaneum.This is traumatic or it can complicate seronegative spondarthritis .Raising the shoe heel reduces pain.Occasionally a low-pressure corticosteroid injection near the enthesis is necessary.
Partial tear of the Achilles tendon causes a painful ,tender swelling a few centimetres above its insertion.Advise against walking barefoot and jumping .Therapeutic ultrasound is helpful.( Caution - a local injection may cause the tendon to rupture .)
Achilles bursitis lies clearly anterior to the tendon and can be safely injected with corticosteroid.
COMPARTMENT SYNDROMES
The muscles of the lower leg are enclosed in facial compartments ,with little room for expension to occur.Compartment syndromes can be acute and severe ,such as following exercise.
In the anterior tibial syndrome there is severe pain in the front of the shin ,occasionally with foot drop. Immediate surgical decompression to prevent muscle necrosis is sometimes required.
Chronic compartment syndrome produces pain in the lower leg that is aggravated by exercise and may therefore be mistaken for a vascular or neurological disorder.
Plantar fascitis is an enthesitis at the insertion of the tendon into the calcaneum .It produces localized pain when standing and walking ,and tenderness in the mid line.It occurs alone or in seronegative spondarthritis.
Plantar spurs are traction lesions at the insertion of the plantar fascia in older people and are usually asymptomatic.They become painful after trauma.
Calcaneal bursitis is a pressure - induced ( adventitious ) bursa that produces diffuse pain and tenderness under the heel.Compression of the heel pad from the sides is painful ,which distinguishes it from plantar fascia pain.
Whatever the cause ,the pain is always worse in the morning as soon as weight is placed on the foot.
All of these lesions are treated with heel pads ,and reduce walking ,these are often self-limiting .A splint at night to hold the foot dorsiflexed and to stretch the plantar fascia is preferable to a local corticosteroid injection in plantar fasciitis . When an injection is necessary , a medial approach is used ,rather than through the heel pad ,under a posterior tibial nerve block.
Heel pain causes
-Plantar fascitis ___ below heel.
-Plantar spur ___ below
-Achilles tendonitis / bursitis ___behind heel.
-Sever's disease.
Arthritis of ankle / subtaloid joints.
PAIN BEHIND THE HEEL AND LEG
Sever's disease is a traction apophysitis of the Achilles tendon in young people ( cf.Osgood -Schlatter's disease) .
Achilles tendonitis is an enthesitis at the insertion of the tendon into the calcaneum.This is traumatic or it can complicate seronegative spondarthritis .Raising the shoe heel reduces pain.Occasionally a low-pressure corticosteroid injection near the enthesis is necessary.
Partial tear of the Achilles tendon causes a painful ,tender swelling a few centimetres above its insertion.Advise against walking barefoot and jumping .Therapeutic ultrasound is helpful.( Caution - a local injection may cause the tendon to rupture .)
Achilles bursitis lies clearly anterior to the tendon and can be safely injected with corticosteroid.
COMPARTMENT SYNDROMES
The muscles of the lower leg are enclosed in facial compartments ,with little room for expension to occur.Compartment syndromes can be acute and severe ,such as following exercise.
In the anterior tibial syndrome there is severe pain in the front of the shin ,occasionally with foot drop. Immediate surgical decompression to prevent muscle necrosis is sometimes required.
Chronic compartment syndrome produces pain in the lower leg that is aggravated by exercise and may therefore be mistaken for a vascular or neurological disorder.
