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dear all,

a patient , 34 years working as pt master in school having posterior heel pain for 6 months duration.pain increasing after prolonged standing. clincally no tenderness over the medial calcaneal region.my clincal diagnosis posterior heel pad cushining due to pressure. pt has not satisfied with analgesics, physical heat therapy.
planning for posterior heel cushioning with silicon.

please suggesst how to aproach these kind of problems.

regards
suresh
chennai.india.

 

Is it posterior or posterior plantar?

 

I reckon it's referral from soleus trigger point.
Go to this wonderful site to see how to assess it.
If you are not familiar with trigger point therapy maybe you know of someone to refer to?
Hope this helps a bit.
Cheers
Mahtay

 

dear dr. Craig Payne
it is diffuse pain over the heel cushion area(plantar) , only subjective.
clinically no tenderness. and no other findings
any other diferntial diagnosis

regards
suresh

 

I would go with mahtay - first guess would be a trigger point.

 

Dear Suresh,
If it is plantarly painful, palpate a little anterior to the heel and you may find the Quadratus Plantae muscle bellies triggering.
But also Flexor Digitorum Longus, Abductor Hallucis and a few others around may be contributing, even in a minor synergistic/antagonistic manner.
Hope this helps
Mahtay