Medial Heel Pain

I have a patient who has had a tingling feeling on his medial L heel on his calcaneous. He had pain on gastroc stretch more than soleus. morning stiffness. TOP. no loss of ROM, MMT 4/5 L eversion, all others 5/5.

On palpation the area feels "creaky" as you roll over it.

I have been treating this as retrocalcaneal bursitis using Deep transverse friction, calf stretches, eversion strengthening and US + IF.

The pain has decreased but patient phoned today to book a further appt as he still has TOP but no feeling of the problem normally. And he is worried about returnign to sport as he cycles 2-3 times a week and runs 2-3 times per week.

I am querying if this is actually bursitis as it is around 2-3 cm away from his TA insertion. Are there any other local structures in this area? ? there seems to be no neuro involvement, Lsp Hip and Knee cleared.

Any suggestions?

Regards,

Have you considered fat pad syndrome or tibial nerve entrapment? Check out David Butler as a resource for checking the tibial nerve (may be caught within or behind the tight gastroc). Also check his cycling technique, is he staying in plantar flexion throughout his downstroke? He should be starting his upstroke with his hamstrings by keeping his heel lower than his toes. A lot of people have the bad habit of keeping their toes pointed throughout their cycle stroke.

Best of luck with the differential diagnosis.

K

Pain on the centermost heel that is a lot of apparent anon aloft ascent and afterwards blow a lot of frequently indicates plantar fasciitis. Palpation of the centermost calcaneal tubercle will arm-twist pain. Squeezing the physique of the calcaneous generally indicates calcaneal accent fracture, Affliction on the after heel indicates Achilles tendonitis,bursitis.

This patient is now resolved. I believe that the residual problems were psychological. The only tenderness was on hard palpation. I taped for re assurance and he is now fine.