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Rearfoot Conditions

Many conditions can cause serious discomfort or pain in the rearfoot. By far the most common complaint is heel pain which can be attributed to a number of conditions.

Plantar Fasciitis (Heel Pain)

Plantar Fasciitis is the most common cause of heel pain seen by Podiatrists. Most people who suffer from this condition experience severe pain in the heel of the foot when taking their first few steps out of bed in the morning or after prolonged sitting. The pain classically occurs again after lunch, and after exercise. Some people feel a sharp/stabbing pain, whilst others feel a dull ache.

If plantar fasciitis is not treated appropriately it may become a chronic condition and will prevent you from walking. It may also contribute to developing symptoms in your feet, knees, hip and back due to the changes in the way in which you walk to accommodate the condition.

The good news is that Plantar Fasciitis can be treated relatively easily and results of treatment can be felt quickly. A thorough medical history, assessment of the symptoms, analysis of foot function and footwear will confirm diagnosis. In some cases it may be necessary to have an X-Ray to rule out other conditions including heel spurs.

The treatment regime normally consists of a combination of stretches, ice, rest, footwear and insoles.

Achilles tendonitis

Achilles tendonitis pain is often felt in the lower third of the Achilles tendon, approximately 5cm from its insertion into the heel. Pain can also occur at the tendon’s attachment site to the heel. Achilles tendonitis can be either acute or chronic. Symptoms are aggravated by activity and relieved by rest.

It is caused by overuse or excessive strain on the achilles tendon and accounts for an estimated 11% of all running injuries. Poor foot mechanics and excess pronation is often a factor that goes unnoticed. Achilles tendonitis is often now referred to as achilles tendinopathy. This is because it is thought to be due to tendon fibre degeneration rather than inflammation.

Treatment outcomes are best if treated early. The tendon has a poor blood supply meaning that healing is often slow so don’t let this problem progress into the chronic form.

Sever’s disease

Sever’s disease is a common cause of heel pain, particularly in the young and physically active. During puberty the calcaneus (heel bone) consists of two areas of bone known as ossification centres. These two areas are divided by an area of cartilage known as the calcaneal apophysitis.

The Achilles tendon attaches the triceps surae (calf muscles) to the calcaneus. As a child grows the calcaneus grow faster than the surrounding soft tissue, which means the Achilles tendon is pulled uncomfortably tight. This increase in tensile load can cause inflammation and irritation of the calcaneal apophysis (growth plate) which is known as Sever’s Disease. The pain is exacerbated by physical activities, especially ones involving running or jumping. Sever’s disease most commonly affects boys aged 12 to 14 years and girls aged 10 to 12 years, which corresponds with the early growth spurts of puberty.

Treatment can include rest, ice, insoles, stretches.

Haglunds deformity

Haglund’s deformity is a bony enlargement on the back of the heel. The soft tissue near the Achilles tendon becomes irritated when the bony enlargement rubs against shoes. This often leads to painful bursitis, which is an inflammation of the bursa (a fluid-filled sac between the tendon and bone).

Non-surgical treatment of Haglund’s deformity is aimed at reducing the inflammation of the bursa. While these approaches can resolve the pain and inflammation, they will not shrink the bony protrusion. Non-surgical treatment can include one or more of the following: Anti-inflammatory drugs, ice, stretches, heel lifts, shoe modification, rest, orthotics.

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