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Heel Pain

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Having a tight calf muscle is almost always a contributing factor in various forms of heel pain and is the focus of the very successful, non-operative treatment regimens.

Heel pain usually occurs either on the back of the heel where the Achilles tendon inserts into the bone (insertional Achilles tendinitis) or on the bottom of the heel where the plantar fascia inserts (plantar fasciitis). They have common etiologies, are related, and often treated non-operatively in a similar manner. Patients having a tight calf muscle is almost always a contributing factor in these problems and is the focus of the non-operative treatment regimens.

Symptoms

The pain is located in one of these two areas and is usually worse in the morning just after getting out of bed. This occurs because while sleeping the Achilles tendon or plantar fascia tightens. When you first bear weight on that leg, the tissue gets stretched and small microtears occur. The pain is usually improved as you become more active during the day and then can worsen later in the day again. When these problems become more severe they can become consistently painful. Patients with insertional Achilles tendinitis may notice that a bump on the back of the heel has developed over the years. This is usually a combination of inflammation and bone spurs that have formed in this area.

Treatment

Plantar fasciitis can normally be successfully treated non-operatively. This can sometimes take many months to resolve. Non-operative treatment consists of calf and plantar fascia stretching with or without formal physical therapy, anti-inflammatory medications, topical medications, ice, activity modification, heel cups or orthotics, night splints, and possibly steroid injections. Rarely, plantar fasciitis can persist despite these conservative modalities and surgical intervention is considered. Surgical options include calf muscle lengthening and plantar fascia release.

Insertional Achilles tendinitis is treated initially with all the same non-operative modalities as plantar fasciitis with the exception of steroid injections. At times, when severe, your surgeon may suggest wearing a special boot or even a cast for a duration of time in order to control the pain and allow the inflammation to decrease. If the problem persists for many months, surgical intervention is considered. The goal of surgery is to remove the damaged portion of the tendon and the bone spurs and re-attach the healthy tendon to the heel bone with strong anchors. Post-operatively, a boot or cast is worn and weight bearing on that leg is usually allowed.

Achilles Reconstruction Case Example:

Achilles Reconstruction Case Example