REARFOOT PAIN
Posterior Heel Pain can be caused by several conditions that result in discomfort in the back of the heel.
Below are the most common conditions of posterior heel pain.
Superficial Calcaneal Bursitis/ Adventitious Bursa (Haglund’s deformity)
Superficial Calcaneal bursitis is a rearfoot condition which involves a bursa, a small fluid filled sac that provides cushioning and reduces friction between the heel bone and skin becomes inflamed. This inflammation can be caused by repetitive stress or trauma to the heel such as when running or wearing tight fitted footwear where the heel bone rubs on the inside of the heel component of the shoes.
The symptoms of this rearfoot condition include pain, swelling and tenderness in the back of the heel. The skin of the affected area may become red and warm to the touch. In some cases, there is a ‘lump’ that forms and is referred to as Haglund’s deformity.
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Generally, you’ll notice the common symptoms of pain when in shoes. Pain, swelling and tenderness can be often felt before the appearance of a ‘lump’.
It is important to consult with your podiatrist to properly diagnose and determine the best management plan for you.
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Short term management of superficial calcaneal bursitis often involves rest, ice, compression and elevation to address the immediate symptoms. This is followed by footwear assessment and ensuring you’re wearing the appropriate shoes for your feet.
Long term management of superficial calcaneal bursitis will tend to involve podiatry intervention, assessment and correction of your postural alignment of the feet as well as overall leg alignment, knee and hip position with recommendation of custom foot orthoses.
Retrocalcaneal Bursitis
Retrocalcaneal bursitis is a condition where the bursa (fluid filled sac) located between the Achilles tendon and heel bone becomes inflamed. This bursa provides both cushioning and reduces friction between the Achilles tendon and the bone.
The symptoms of this rearfoot condition include pain to either the inside or outside of the Achilles insertion onto the heel. This condition is aggravated with running and jumping. The cause of retrocalcaneal bursitis can include overuse or repetitive stress on the Achilles tendon, wearing tight-fitting shoes that put pressure on the back of the heel bone and injury to the heel bone.
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The location of your pain can differentiate retrocalcaneal bursitis from other rearfoot conditions. Also, being mindful of your activities during the time and onset of pain i.e. where you exercising a lot (skipping, jumping, running), what shoes do you frequently wear?
It is important to consult with your podiatrist to properly diagnose and determine the best management plan for you.
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Short term management of retrocalcaneal bursitis often involves rest, ice, compression and elevation to address the immediate symptoms. This is followed by footwear assessment and ensuring you’re wearing the appropriate shoes for your feet. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) e.g. Ibuprofen may be recommended to relieve pain and inflammation. Physical therapy and stretching exercises may be recommended to improve flexibility and strength in the affected area.
Long term management of Retrocalcaneal bursitis will tend to involve podiatry intervention, assessment and correction of your postural alignment of the feet as well as overall leg alignment, knee and hip position with recommendation of custom foot orthoses. In severe cases, corticosteroid injections or surgery may be required to alleviate symptoms.
Insertional Achilles Tendinopathy
Insertional Achilles tendinopathy is a painful and often debilitating inflammation of the Achilles tendon at its insertion site on the heel bone. Insertional Achilles Tendinopathy often arises with chronic overuse or as a result of trauma to the area.
The symptoms for Insertional Achilles Tendinopathy include pain and stiffness the in the back of the heel, especially with activities such as walking and running. The pain can be more noticeable in the morning or after prolonged rest.
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If you’re experiencing pain and/ or stiffness at the back of your heel bone, that tends to get worse with activity such as walking, running, jumping etc and you’ve been quite active recently then It is important to consult with your podiatrist to properly diagnose and determine the best management plan for you.
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Short term management of Insertional Achilles Tendinopathy often involves rest, ice, compression and elevation to address the immediate symptoms. This is followed by careful physical therapy and stretching exercises in order to improve flexibility and strength in the affected area. However, it should be noted that there is conflicting evidence on the research for acute symptoms. Non-steroidal Anti-Inflammatory Drugs (NSAIDS) e.g. Ibuprofen may be recommended to relieve pain and inflammation as well as bracing, taping and reduction in activity load. If initial conservative measures fail to reduce symptoms, corticosteroid injections are often advised.
Long term management of Insertional Achilles Tendinopathy will tend to involve podiatry intervention, assessment and correction of your postural alignment of the feet as well as overall leg alignment, knee and hip position with recommendation of a cast or walking boot to immobilize the foot to allow for healing. In severe cases, surgery may be required to repair the damaged tissues in the Achilles or reattach the Achilles tendon to the bone.
Tibialis Posterior Tendon Dysfunction
Tibialis Posterior Tendon Dysfunction is a condition which occurs when the Tibialis Posterior Tendon, which runs along the inside of the ankle and foot, becomes inflamed or damaged. This condition can cause pain, weakness in the feet and instability of the foot and ankle.
If not diagnosed with early treatment, the condition can result in significant pain, foot deformity, gait dysfunction, impaired mobility and poor function. Typically, the condition is commonly seen in occurring in people who engage in activities that put repetitive stress on the tibialis posterior tendon such as running, dancing or playing sports. It can also occur as a result of trauma or injury to the foot and ankle.
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Symptoms can include severe pain and weakness on the inside of your ankle that may course down to the arch of the foot, swelling, aching or throbbing in the ankle of the feet, and a feeling of instability or weakness in the ankle of foot. The Tibialis posterior tendon is a very important in maintaining the arch of the feet. When this is damaged or weakened, it can lead to progressive flatfoot deformity making it difficult to walk, run or engage in physical activity.
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Stage 1: Tibialis posterior tendon becomes inflamed and swollen but there is no significant damage or tearing to the tendon. You may experience pain and swelling on the inside of the ankle which can course down into the arch of the feet, but the feet remain stable, arch height is maintained, and most can still perform daily activities.
Stage 2: In this stage, the tibialis posterior tendon begins to stretch and lose the ability to support the arch of the feet. Therefore, the arch of your feet may begin to show signs of lowering in its height. This can cause the foot to become unstable, causing severe and chronic pain and swelling, especially during physical activity.
Stage 3: In this stage, the tibialis posterior tendon is significantly weakened or torn. This will lead to a complete collapse of the medial arch of the foot. Patient’s may experience severe pain and weakness with difficulty walking or standing for long periods of time.
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Early diagnosis and conservative podiatric intervention and management can help slow the progression of the disease and prevent the need for surgery. The use of custom orthotics or arch innersoles are great to alleviate pain and inflammation by reducing tension on the tendon. Orthotics can prevent further damage to the tendon by improving overall foot and ankle alignment and redistribute the weight and pressure on the feet.