Heel Pain: Causes, Diagnosis, and Treatment Options

Heel pain!!

Hello, Doctor.
I have been experiencing heel pain due to exercise.
The affected area feels like something is pulling and there is a tearing pain.
The pain became unbearable, so I sought medical attention.
Since the pain is located on both sides of the calcaneus, the X-ray did not show any obvious issues.
After several months of ineffective rehabilitation, the doctor arranged for more precise examinations, which revealed that the Achilles tendon was not injured, but there was a tear in the slightly concave areas of the calcaneus, indicating a fracture.
The doctor explained that the pulling sensation was due to the displacement of the fracture and recommended wearing a cast for 8 weeks.
During the casting period, I still felt movement and pain in the affected area, so I returned to the doctor for a follow-up.
The doctor checked the condition of the cast and believed it was adequately immobilized.
At the beginning of April, after 8 weeks of immobilization, the cast was removed.
Due to swelling in the foot, rehabilitation was arranged.
After two weeks of rehabilitation, the swelling has mostly subsided, but there is still pain on both sides of the calcaneus.
It seems that the cast did not fully stabilize the tear.
The physical therapist suspects that because the injury is located in the concave area of the calcaneus, it could not be completely immobilized.
It has been over six months since the pain started, and it is truly unbearable! I would like to ask you, Doctor, how should I proceed now?

A-Hsien, 30~39 year old female. Ask Date: 2004/04/16

Dr. Shi Guozheng reply Orthopedics

First, it is essential to confirm whether it is a fracture.
If it is not caused by a fracture, the most likely condition is tendinitis.
Pain may occur at the junction of the Achilles tendon and the calcaneus due to sports injuries.
The treatment for tendinitis typically involves medication, rehabilitation, and local injections.
It is advisable to seek a detailed evaluation from another physician.

Reply Date: 2004/04/16

More Info

Heel pain can be a debilitating condition, especially when it stems from injuries such as fractures or tendon issues. Based on your description, it seems that you have been dealing with a significant injury to your heel, specifically a tear in the bone around the calcaneus (heel bone). This type of injury can be quite complex, and the pain you are experiencing may be due to several factors, including the nature of the fracture, the healing process, and the effectiveness of the immobilization provided by the cast.

Understanding Heel Pain
Heel pain can arise from various causes, including:
1. Plantar Fasciitis: Inflammation of the plantar fascia, a thick band of tissue that runs across the bottom of the foot.

2. Achilles Tendonitis: Inflammation of the Achilles tendon, which connects the calf muscles to the heel bone.

3. Heel Spurs: Bony growths on the underside of the heel bone, often associated with plantar fasciitis.

4. Fractures: Stress fractures or acute fractures can occur due to trauma or overuse.

5. Bursitis: Inflammation of the bursa, a small fluid-filled sac that reduces friction between tissues.

Diagnosis
In your case, the diagnosis of a tear in the bone around the calcaneus, as indicated by the imaging studies, suggests a more serious underlying issue. The fact that the X-rays did not show any obvious problems may indicate that the fracture is subtle or that the displacement is minimal, which can sometimes be missed on standard imaging.

Treatment Options
1. Rest and Immobilization: It’s crucial to allow the injury to heal properly. If the cast was not effective in immobilizing the area, you may need to discuss alternative methods of immobilization with your doctor, such as a walking boot or a more rigid cast.

2. Physical Therapy: Once the initial healing has occurred, physical therapy can help restore strength and flexibility to the area. A physical therapist can provide exercises tailored to your specific needs and monitor your progress.

3. Pain Management: Over-the-counter pain relievers such as acetaminophen or NSAIDs (like ibuprofen) can help manage pain and inflammation. However, it’s essential to use these medications as directed and consult your doctor if you find yourself relying on them frequently.

4. Advanced Imaging: If pain persists, further imaging studies, such as MRI or CT scans, may be necessary to assess the extent of the injury and to rule out any complications, such as non-union of the fracture or other underlying conditions.

5. Surgical Intervention: In cases where conservative management fails, surgical options may be considered to repair the fracture or address any complications. This would typically be a last resort after exhausting other treatment options.

6. Gradual Return to Activity: Once you have received clearance from your healthcare provider, gradually reintroducing activities can help prevent re-injury. It’s important to listen to your body and not rush the healing process.

Conclusion
Given that you have been experiencing pain for over six months, it’s crucial to follow up with your healthcare provider to reassess your condition. They may need to adjust your treatment plan based on your current symptoms and the results of any new imaging studies. It’s also important to communicate openly about your pain levels and any concerns you have regarding your recovery. Remember, healing can take time, and it’s essential to be patient and persistent in seeking the appropriate care for your heel pain.

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