Painful PCA - HELP!

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I have a 40 y.o. female patient with painful right plantar calcaneal area.
Painful on compression on the entire plantar calcaneal area.
Pt has a hx of depression and is slightly overweight.
No fat pad atrophy present.
Advised wearing cushioning shoes, using ice therapy, massage, low dye strapping, padding techniques (d-fillers, heel lifts), all of which have not assisted to relieve pain, and mostly pt was uncompliant with the tx options mentioned.
I have sent for x-rays hoping something might show up.
Pt was very active when younger with netball, but no longer plays sport.
She does do alot of running around with the kids for school and their sporting activities.
Pt did comment today she has hx of back pain...
Does anyone have any advice on this frustrating case of tx options or what the pain maybe caused from????

 

Hi Lauren,

I'd be wanting to check for and rule out the neurogenic causes of heel pain. This would involve: Tinel's test; Straight leg raise test; Dorsiflexion/eversion test; Phalen's test (plantarflexion/inversion) and palpation of the porta pedis (which could also be an abductor hallucis trigger but be guided by the referral pattern). Also check for quadratus plantae and soleus triggers as they refer to the entire plantar surface of the heel.

There was a recent thread on plantar heel pain which Admin posted some great papers about the differential diagnosis of plantar heel pain. I will email you my review of these and some other papers on the subject.

Rebecca