Differential diagnosis and treatment of heel pain

Heel pain caused by heel spur syndrome is a common finding in the podiatric community. It can be baffling and frustrating to the podiatric physician when its rectification becomes conservatively prolonged. This article helps the podiatric physician realize that heel pain may be present whether there is a spur or not and helps give a basic understanding of the systemic disorders that can be involved with heel pain.     

Trigger point therapy and plantar heel pain: A case report

The cause of plantar heel pain and fasciitis has continued to be a diagnostic challenge even though it is one of the most common musculoskeletal disorders of the foot and ankle. The subject has evoked strong emotions and sparked intense debate regarding the likely causes and effective treatment options. Myofascial trigger point as a treatment option for plantar heel pain and fasciitis has been inconspicuous. The full extent of its significance and potential is largely unexplored in podiatric literature and medicine. Myofascial trigger point may offer an alternative explanation of the etiology of plantar heel pain and fasciitis.     

Tibialis posterior myofascial tightness as a source of heel pain: diagnosis and treatment

STUDY DESIGN: We report 2 cases in which a novel tibialis posterior muscle stretch is used to treat heel pain and lower extremity impairment. OBJECTIVES: To explore dysfunction of the tibialis posterior as a source of heel pain. BACKGROUND: Heel pain is a common symptom of orthopaedic dysfunction of the lower extremity. Tibialis posterior tendon dysfunction is well documented in the medical and surgical literature, but its identification in its early or precursive stages has received little attention. METHODS AND MEASURES: An examination and treatment outline, incorporating a novel assessment and stretching technique, is presented. RESULTS: We identified a stage of dysfunction of the tibialis posterior ("Pre-Stage 1") without clinically identifiable tendon pathology. We refer to this as tibialis posterior myofascial tightness (TPMT). CONCLUSION: Tibialis posterior myofascial tightness is a clinical entity that may be differentially diagnosed in cases of heel pain and specifically treated.     

顽固性跟痛症的选择性治疗

顽固性跟痛症的病因复杂 ,治疗方法较多 ,但效果有时不太理想。 1995年7月～ 2 0 0 1年 5月 ,我科收治 4 0例顽固性跟痛症患者 ,根据不同情况以不同方法治疗 ,疗效满意。1　材料与方法1.1　病例资料　本组 4 0例 ,男 2 6例 ,女 14例 ,年龄 2 0～ 6 4岁。共 4 4足 ,其中单足左侧 2 1例 2 1足、右侧 15例 15足 ,双足 4例 8足。均有长期慢性足跟疼痛 ,病程 6个月以上 ,反复发作 ,症状重。保守治疗无效。排除骨关节炎、强直性脊柱炎、创伤性关节炎、跟腱滑囊炎、跟骨骨骺炎、扁平足、骨结核、骨感染、骨肿瘤引起的跟痛。1.2　方法1.2 .1　清晨开…     

Papillary eccrine adenoma of the heel: a case report.

Papillary eccrine adenoma is a rare, slow-growing cutaneous tumor of sweat gland origin. It is a benign lesion that occurs most often in the distal extremities. Only 33 cases have been reported in the literature with few located in the distal lower extremity. There have been no cases reported in the podiatric literature. The clinical and surgical history of a case report of a papillary eccrine adenoma in a 35-year-old white male is presented.     

A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: a case series

STUDY DESIGN: Case series. OBJECTIVE: To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. BACKGROUND: There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. METHODS AND MEASURES: Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. RESULTS: Symptom duration ranged from 6 to 52 weeks (mean duration+/-SD, 33+/-19 weeks). Treatment duration ranged from 8 to 49 days (mean duration+/-SD, 23+/-18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average (+/-SD) of 5.8+/-2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. CONCLUSION: In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairment-based physical therapy interventions for patients with plantar heel pain/plantar fasciitis.     

Late diagnosis and treatment of palmar trans-scapholunate dislocation: a case report

Abstract Palmar trans-scapholunate dislocation is an uncommon injury. It requires an immediate and accurate diagnosis and surgical treatment in emergency room, in order to obtain early decompression of the median nerve and to avoid necrosis of the scaphoid or lunate. After open reduction, the lunate is usually stabilized using Kirschner wires. The scaphoid is stabilized with a Herbert’s screw. We describe a case of palmar trans-scapholunate dislocation, with palsy of the median nerve, treated surgically 25 days after trauma. We performed decompression of the median nerve, open reduction of the lunate and stabilization of the scaphoid using a Herbert’s screw. The clinical, radiographic and neurophysiological results at the follow-up performed 18 months after surgery are shown. We believe that early diagnosis and treatment are necessary. Moreover, we think that, if the scapholunate ligaments are intact, the volar wrist capsule is accurately sutured, and the stabilization of the scaphoid fracture is correct, it is not necessary to use Kirschner wires to fix the lunate.     

Neurilemmoma in the foot as a cause of heel pain: a report of two cases

Two cases of deep-seated neurilemmoma that arose from plantar branches of the posterior tibial nerve and caused chronic heel pain are described. At the initial examination, one case was misdiagnosed as tarsal tunnel syndrome and the other was overlooked as plantar fasciitis; both cases were treated for long periods prior to operation. Deep-seated neurilemmomas in the foot can easily be overlooked and misdiagnosed as tarsal tunnel syndrome or plantar fasciitis because of the rarity, absence of palpable mass, and similarity of symptoms to those of other frequently encountered foot disorders. Magnetic resonance imaging provides the best modality for differential diagnosis. In the present cases, surgical excision of the tumors resulted in immediate and complete relief of chronic heel pain. Surgeons should consider neurilemmoma as a cause of persistent chronic heel pain despite the rarity of the disease.     

Large soft tissue osteochondroma of the heel: a case report and literature review

Soft tissue osteochondromas are the rare tumors of the foot. We present an unusual case of a 30-year-old woman who had a large osteochondroma originating from the soft tissue in the heel region. She made an uneventful recovery following excision. No recurrence was noted at 36 months follow-up. To the best of authors’ knowledge, such presentation has not been reported before in the English language-based medical literature.