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Medial Heel Pain after rest

Discussion in 'Biomechanics, Sports and Foot orthoses' started by issy1, Sep 8, 2010.

  1. issy1

    issy1 Active Member


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    I posted a thread this morning regarding a fairly inactive 47 year male slightly overweight who complains of shooting pain on medial side of left foot heel pad for few minutes after rest, no pain when walking. He fractured both ankles on different occasions many years ago. Heel pain started about 2 years ago.

    When I returned to this thread later I realised I was getting a good old ridiculing that I could not recognise the symptoms of plantarfasciitis. I posted a reply to rectify what I believe to be a misunderstanding about where this pain actually was but the thread was removed by admin. probably before anyone saw it. I am very aware of the symptoms of plantarfasciitis and when the gentleman was giving me his history it was my obvious thought but then he pointed very specifically to a spot on the medial heel pad, not plantar medial heel pad ie about 2.5cm in from the back of the heel and about 2cm up from the bottom of the heel pad on medial side, posterior to deltoid for want of a better discription.) This may well be a symptom of plantarfasciitis but I have to hold up my hands and admit I have never had anyone with plantarfasciitis discribe pain it in this area before. Due to short time slot I had used low dye strapping and given him plantarfascia and gastro stretches (lunge of 28 degrees) to do with review in 2-3weeks. I really would appreciate your advise but please don't stone me again!
     
  2. David Smith

    David Smith Well-Known Member

    There's probably some trauma or pressure to the medial calcaneal nerve. Nerve pain often manifests during rest. The common heel pain that is described by patients that is from prolonged pressure on the heel when they are sitting for a long time with their heel resting on the ground. The solution is to remove the pressure and icing will also help. Perhaps the heel counter of the shoe is to narrow or is distorted in some way or maybe he usually sits with opposite foot resting on the symptomatic heel. He may have damaged the nerve when he fractured the ankle or possibly he has tarsal tunnel syndrome, but this would tend to have more wide spread symptoms into the medial foot.

    There's some things to be going on with,
    Regards Dave Smith
    Its better to ask a question and look silly for a moment than to spend your life in ignorance.
     
  3. Dear Issy ,

    While I hope that you did not feel I was giving you a good stoneing and was trying to help.

    the information you provided to us did not included

    So we can only go on what you provide, While I agree William was a little harsh maybe you should look at what you wrote.

    I make mistakes and spell badly etc, but If I do the best thing to say is Sorry I forgot some information and update the information and move on.

    So maybe go back look what you wrote and then read what you wrote in this and see the difference.

    People are here to help if you want it but we can only go on what you provide.
     
  4. issy1

    issy1 Active Member

    Thank you for replies. David would nerve damage suggested not have symptoms of pins and needles, numbness etc which he does not complain off?. M Weber, yes I can see now that a description of 'medial heel pad pain' was sketchy and it never even occured to me to mention the word plantarfasciitis due to position of pain but that's what it is to type whilst in your own thought pattern. Have learn't my lesson:eek:
     
  5. Timm

    Timm Active Member


    I would add Issy, with restricted Lunge and history of bilateral ankle fractures, is the restricted lunge due to a bony ankle equinus or is it soft tissue in nature. Obviously, with a bony ankle equinus calf stretches aren't going to be of benefit for this patient so will need to look at adding heel raises with possible ankle mobilisations to accomodate for an ankle equinus to help prevent any compensations that may be contributing to a nerve compression at this site.

    Did you test for a positive Tinel's sign?
    Did you estimate the STJ axis location (ie fairly standard, medially deviated or laterally deviated)?


    Just a thought. Good luck. Nerve entrapment sounds like likely cause to me.

    Tim
     
  6. Ian Linane

    Ian Linane Well-Known Member

    Hi Issy

    I think Dave Smith has given you something to chew on and I have had people present with similar symptoms to find it to be the nerve. Certainly, many of those I have dealt with have respond to careful soft tissue mobilisation.

    Given the history of fractured ankles I would be tempted to consider Maitland posterior anterior glide and vice =-a-versa to aid restoring any limitation of dorsiflexion at the talocrural joint and add into that further Maitland peripheral mobilisations for accessory motions there as well. These are simple techniques.

    Cheer
    Ian
     
  7. David Smith

    David Smith Well-Known Member

    No

    From re reading your description I'm not sure if by 'pain after rest' you mean after he has been resting for a while or weight bearing after rest - because later you say it does not hurt when walking, which required an initial weight bearing time.

    BTW - You do not have to call something plantar fasiitis just because it is on the foot and hurts on weight bearing. Call it what you like, but first identify the tissue that is pathological and and what it'slikely aetiology was then determine how you want to fix it.

    Dave
     
  8. issy1

    issy1 Active Member

    When he weight bears after resting or at initial contact in morning he has pain for few minutes but this eases when he walks. However if he has been on his feet alot during the day the pain is much worse on initial contact after sitting or in the morning.

    If the structures in this area, flexor retinaculum or abductor hallux where damaged or being traumatised due to mechanical problem you would expect pain when walking? Nerve entrapment I guess is possible although he does not complain of any numbness or tingling - will check for Tinel's
     
  9. Ella Hurrell

    Ella Hurrell Active Member

    Hi Issy

    In my experience, nerve irritation in this area (I believe this is also known as Baxter's nerve syndrome/1st branch of the lateral plantar calcaneal nerve?) does not always produce numbness/pins and needles etc. It is often just a sharp pain/shooting pain that is described. Would others agree?
     
    Last edited: Sep 15, 2010
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