CHRONIC HEEL PAIN

By DR/ Hesham Maher

Resident of orthopedic surgery
Hellwan general hospital

According to the site :

Lateral.
Plantar Medial.
Plantar posterior .
Plantar central.
Posterior.

LATERAL:

Stress fracture.
Axial X.ray, Bone scan.
Treatment :
rest.
Activity modification.
Short leg cast.

PLANTAR MEDIAL:
Plantar fasciitis.
Bone spur is NOT the source of pain.
Worse with the 1st steps at the mourning or after a
period of rest.
TTT : Activity modification, NSAIDS, Heel cups,
Orthotics for pes planus, Steroid injection, Surgical
release .

Nerve to ADQ entrapment.

Tarsal tunnel syndrome.

+ve Tinels sign, EMG.
TTT: Conservative, Decompression.

PLANTAR POSTERIOR:
Inflammatory arthropathy.

- Rheumatoid arthritis.
- Seronegative arthropathy,
Eg, Reiters syndrome

PLANTAR CENTRAL:

Fat pad atrophy.

Aging, Rh arthritis.Heel
cups.

Soft tissue tumor.

MRI, Biopsy Lipoma, Fibroma,
Vascular tumor.

Periostitis.

POSTERIOR:

Calcaneal prominence:
Haglunds deformity.

No calcaneal
prominence:
Os trigonum.
Superficial tendoachilles bursitis.
Stress fracture.