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Hi
I saw a patient last week who I have previously treated for plantar fasciitis. This calmed with physical therapies and custom orthoses which she still wears.
However
She has recently developed pain at the posterior aspect of her calcaneus. Basically right on the turning of the bones plantar to non plantar area.
I have gotten x-rays and ultrasound taken but they did not show anything untoward in this area.
Have any of you come up against anything like this before?
Is it possibly neuropathy or entrapment?
Or should I look at getting an MRI or bone scan for the area?
The pain is somewhat sporadic. ..although it does only occur during weight bearing periods but not consistently. And I was u able to palpate any pain.
If you have any ideas I would be grateful.

Thanks

Jaimee

 

Check the calf muscles for trigger points

 

Make sure the orthotic has not slid anteriorly in the shoe. Check orthotic impression in sock liner.

 

The two comments, Payne and Fuller, illustrate for me what I love about podiatry.
Either or both may have supplied the solution for the problem.
We are the guys who can look and treat a wide range of options to solve the probelms coming in the door.

 

As Eric noted, when seeing relatively sudden onset of posterior-plantar heel pain in an orthotic-wearing patient, it generally means the orthosis has slid anteriorly inside the shoe, most commonly due to the orthosis being put into a shoe that has a relatively narrow heel or due to the orthosis being put on top of a shoe sock liner with a heel cup.

 

I use the following criteria when examining the inferior heel. If you press on the site where the patient complains of pain, there will be one of two outcomes. It will either hurt or not. If not, think referred pain as Craig suggested. If yes, then Eric is likely correct. You can also make sure that if the orthotic has a heel post, it is adequately tapered so that it fits into the heel seat and is not pushed forward.

Howard

 

Then there is the elderly non english speaking client who put the orthotics in the opposite shoes.