Tag: heel pain

Haglunds Deformity

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Haglunds deformity is an anatomic variation in which the back of the heel bone is larger than normal. Generally there is nothing wrong with that except that pressure from the shoes can be painful.

Haglund’s deformity, sometimes nicknamed the “pump bump,” is a bony enlargement that develops on the back of the heel, right where the Achilles tendon attaches to the heel bone (calcaneus). It gets its nickname because it often affects people who wear stiff, high-backed shoes—like pumps or certain dress shoes—that constantly rub against the heel. That repetitive pressure and friction can irritate the area, causing inflammation, swelling, and sometimes blistering or redness over the bony bump. It’s not just limited to fashionable footwear, though—any tight or poorly fitting shoe can contribute.

So what causes Haglund’s deformity in the first place? It’s often a combination of factors. Some people are just anatomically more prone to it—like those with a high arch, a tight Achilles tendon, or a naturally prominent heel bone. These structural factors put more pressure on the back of the heel when walking or running, especially if combined with the wrong type of footwear. Over time, that repeated stress can lead to bone growth and soft tissue irritation, particularly in the bursa—a fluid-filled sac that cushions the tendon. When this bursa gets inflamed, it’s called retrocalcaneal bursitis, and it makes the whole area painful and swollen.

Symptoms typically include a noticeable bump on the back of the heel, pain where the Achilles tendon attaches, and swelling or redness around the area—especially after wearing shoes that aggravate it. The pain often worsens with activity, particularly walking uphill or climbing stairs, and can make certain shoes impossible to wear comfortably. If the tendon gets involved due to chronic friction or inflammation, it can lead to Achilles tendinopathy, which adds even more discomfort and stiffness.

Treatment usually starts conservatively: switching to softer, open-backed shoes, applying ice to reduce inflammation, using heel pads or orthotics to relieve pressure, and stretching the Achilles tendon to loosen it. Anti-inflammatory meds (like ibuprofen) can help, too. If conservative methods don’t bring relief, especially if there’s significant pain or tendon involvement, a doctor might recommend physical therapy, cortisone injections (though cautiously around the tendon), or in more persistent cases, surgery to remove the excess bone and inflamed tissue. The key to managing Haglund’s deformity is early recognition and adjusting footwear and activity to prevent long-term complications.

Most Useful Resources:
Haglunds Deformity (Foot Health Forum)
The Haglunds deformity or ‘Pump Bump’ (Foot Health Friday)
Haglunds in an elite marathon runner (Podiatry Arena)
The Pump Bump (Podiatry Ninja)
Haglunds Deformity (Best Running Shoe)

Plantar Heel Fat Pad Atrophy

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The fat pad under the heel protects the foot by providing cushioning and shock absorption. A problem can arise if that fat pad atrophies and it can result in heel pain.

Most Useful Resources:
Heel fat pad atrophy (Foot Health Forum)
heel pad atrophy HELP (Foot Health Forum)
Fat pad atrophy (PodiaPaedia)
Heel Fat Pad Atrophy (Foot Health Friday)
Heel Fat Pad Atrophy Cushioning Pad (FootStore)
Fat Pad Atrophy (Croydon Foot)

Cuboid Syndrome

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Cuboid syndrome is a reasonably common problem affecting the function of the cuboid bone and the joints around it. It is a common cause of lateral foot pain. Manipulation of the cuboid bone is a common treatment.

Cuboid Syndrome is a foot condition that occurs when the cuboid bone—one of the small bones on the outer side of the midfoot—becomes partially dislocated or its alignment is disrupted. This bone plays a key role in supporting the foot’s arch and enabling smooth movement during walking or running. When the cuboid bone is out of place or the ligaments surrounding it are strained, it can cause pain, swelling, and stiffness along the outside of the foot. The condition is sometimes called “subluxation of the cuboid” and is relatively common in athletes, especially runners, dancers, and those who frequently engage in sports with sudden side-to-side movements.

The most common cause of Cuboid Syndrome is overuse or repetitive strain, though it can also result from an ankle sprain or sudden twisting injury. In many cases, the peroneus longus tendon—which runs along the outer side of the lower leg and attaches to the foot—can exert excessive force on the cuboid bone, pulling it out of alignment. Risk factors include poorly fitting footwear, training on uneven surfaces, inadequate warm-up, and having flat feet or very high arches. Because the pain may be mistaken for other injuries, such as a stress fracture or peroneal tendonitis, diagnosis can sometimes be tricky without proper examination.

Symptoms of Cuboid Syndrome typically include sharp or aching pain on the lateral (outer) side of the foot, tenderness when pressing on the cuboid bone, difficulty bearing weight, and pain that worsens with push-off during walking or running. In some cases, there may be visible swelling or bruising. The discomfort often makes the foot feel unstable, and athletes might find themselves limping or avoiding activities that require sudden changes in direction. While rest can sometimes reduce symptoms, the pain often persists until the bone’s alignment is corrected.

Treatment usually starts with a manual realignment technique known as the “cuboid whip” or “cuboid squeeze,” performed by a trained healthcare professional such as a sports physiotherapist or podiatrist. This may be followed by supportive taping, orthotic inserts to stabilize the foot, and targeted stretching or strengthening exercises for the surrounding muscles and tendons. Rest, ice, and anti-inflammatory measures can help manage pain in the short term. For prevention, it’s important to wear properly fitting shoes, gradually increase activity intensity, and maintain flexibility and strength in the foot and ankle. With prompt treatment, most people recover quickly, but ignoring the condition can lead to chronic pain or recurrent injuries.

Most Useful Resources:
Cuboid syndrome (Foot Health Forum)
Mobilisation for cuboid syndrome (Podiatry Arena)
Cuboid syndrome (Podiatry Arena)
Cuboid Syndrome (PodiaPaedia)
Manipulation for Cuboid Syndrome (Podiatry Update)
Woke up with pain on the outer side of my foot, what could it be? (Podiatry Experts)
Could it be plantar fasciitis? (Podiatry Experts)
Cuboid Syndrome (Podiatry TV)

Cancer and the Foot

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Cancer can affect the foot either via a primary tumor in a tissue in the foot or as a secondary tumor from a more proximal metastasis.

Cancer can affect the foot in several ways, both directly and indirectly. Primary cancers of the foot are rare, but tumors can develop in the bones, soft tissues, or skin of the area. For example, malignant melanoma may arise on the skin of the foot, often mistaken at first for something less serious like a mole or wart. Bone cancers such as osteosarcoma or chondrosarcoma can also appear in the small bones of the foot, causing localized pain, swelling, and deformity. Because of the limited soft tissue around the bones in the foot, even small tumors may cause significant symptoms.

The impact of cancer on the foot can also come from metastasis. Cancers originating in other parts of the body, such as the lungs or breast, can spread to the bones of the foot, though this is uncommon. When it does occur, patients may experience persistent, unexplained pain that worsens at night or with weight-bearing activities. Metastatic lesions often weaken the bone structure, increasing the risk of pathological fractures in the foot, which can severely limit mobility and quality of life.

Treatment for foot cancers often involves a combination of surgery, radiation, and chemotherapy, depending on the type and stage of the tumor. Surgery might range from excision of small lesions to partial or full amputation of the affected area if the cancer is extensive. This can have profound consequences for walking, balance, and daily activities. Even when surgery is successful, rehabilitation and custom orthotic support are often necessary to restore function and reduce discomfort.

Beyond the direct effects of cancer, treatments themselves can also impact foot health. Chemotherapy and radiation may cause peripheral neuropathy, leading to numbness, tingling, or burning pain in the feet. These nerve changes can make walking difficult and increase the risk of injuries or ulcers, especially in patients with other conditions like diabetes. Additionally, reduced blood supply from radiation damage or surgical interventions can impair healing in the foot, making it especially vulnerable to infection and long-term complications.

Most Useful Resources:
Cancer (Foot Health Forum)
Cancer threads (Podiatry Arena)
Cancer metastasis in the foot (Podiatry Arena)
Cancer and the Foot (PodiaPaedia)
The Oncologist (Podiatry Apps)

Calcaneal Apophysitis

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Calcaneal Apophysitis is also called Severs Disease and is a common condition of the growth plate at the back of the heel bone in kids.The pain is present at the back and sides of the heel, usually worse after sports activity. As it is a problem with the growth plate, it will come right on its own as the child’s growth in the heel bone stops. It is most commonly treated with a cushioned heel inserts and is a self limiting problem that eventually comes right by itself.

This video from PodChatLive was a good discussion on Calcaneal Apophysitis with an expert in the topic for those who want a deep dive into the topic:

For other videos on Severs disease, see PodiatryTube.

Calcaneal apophysitis, more commonly known as Sever’s disease, is an overuse injury that primarily affects children and adolescents. It occurs at the growth plate (apophysis) in the heel bone (calcaneus), where the Achilles tendon attaches. During periods of rapid growth, especially between the ages of 8 and 15, the bones often grow faster than the muscles and tendons, creating tension at this attachment point. The repetitive stress from activities such as running, jumping, or playing sports can irritate and inflame the growth plate, leading to heel pain. Importantly, despite the name “disease,” it is not an infection or degenerative condition—it is a self-limiting growth-related issue.

The hallmark symptom of calcaneal apophysitis is pain at the back or underside of the heel, which worsens with physical activity and improves with rest. Children may limp, walk on their toes to avoid putting pressure on the heel, or complain of soreness after sports practice. The pain is usually bilateral (in both heels) but can occur in just one heel. Swelling and tenderness may also be present around the heel bone. Unlike plantar fasciitis, which is more common in adults and involves pain under the arch or heel, calcaneal apophysitis is specifically tied to skeletal immaturity and growth plate stress.

Diagnosis is generally clinical, based on history and physical examination. Imaging like X-rays is not always necessary unless there is concern about other causes of heel pain, such as fractures, infections, or tumors. Doctors often perform a “squeeze test,” applying pressure to the heel from both sides, which typically reproduces the pain. Since it’s strongly linked to growth spurts and high-impact activities, understanding the child’s sports involvement and developmental stage is essential. Differential diagnoses may include Achilles tendinitis, plantar fasciitis, or bursitis, but these are less common in this age group.

Treatment for calcaneal apophysitis is usually conservative and focuses on relieving symptoms while allowing the growth plate to heal. Rest and activity modification are crucial, particularly avoiding repetitive jumping and running until symptoms improve. Ice, stretching exercises for the calf and Achilles tendon, and heel cups or cushioned shoe inserts can help reduce stress on the heel. Over-the-counter anti-inflammatory medications may also ease discomfort. Most children outgrow the condition as the growth plate closes, meaning symptoms rarely persist into adulthood. The key is to balance physical activity with adequate rest, ensuring young athletes can continue participating in sports witho

Most Useful Resources on this topic:
Calcaneal Apophysitis (Foot Health Forum)
Calcaneal Apohysitis or Stress fracture (Podiatry Arena)
Calcaneal Apophysitis (Podiatry Arena)
Calcaneal Apophysitis (PodiaPaedia)
Heel Pain in Children (Severs Disease; Calcaneal apophysitis) (ePodiatry)
Severs Disease or Calcaneal Apophysitis? (Croydon Total FootCare)

Baxters Nerve Entrapment

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Baxter nerve entrapment is a cause of heel pain with the symptoms often mimicking plantar fasciitis and should be conisdered in any case of heel pain the has a neurological component to it.

Baxter’s nerve entrapment, also known as inferior calcaneal nerve entrapment, is a relatively common but often overlooked cause of chronic heel pain. The Baxter’s nerve is the first branch of the lateral plantar nerve, and it runs beneath the abductor hallucis muscle before traveling along the medial side of the heel. Because of its position, it is vulnerable to compression as it passes between surrounding structures, particularly the abductor hallucis and the medial calcaneal tuberosity. This entrapment can mimic or coexist with plantar fasciitis, which is why it is frequently misdiagnosed.

The clinical presentation of Baxter’s nerve entrapment usually involves sharp, burning, or radiating pain on the inside of the heel that may worsen with prolonged standing, walking, or running. Unlike classic plantar fasciitis, which is typically most painful during the first steps in the morning, Baxter’s nerve pain can persist throughout the day and sometimes worsens with activity. Patients may also report tingling or numbness along the heel or arch, as the compressed nerve is both sensory and motor. Chronic cases can even lead to weakness of the abductor digiti quinti muscle in the foot.

Risk factors and causes often include repetitive overuse in runners, foot deformities such as flat feet or overpronation, and tightness of the abductor hallucis muscle. External factors, like ill-fitting shoes or excessive standing on hard surfaces, can also contribute to entrapment. In many athletes, the combination of repetitive heel impact and biomechanical stress creates a perfect environment for irritation of the nerve. Because these symptoms overlap with plantar fasciitis, imaging such as MRI or ultrasound, along with careful physical examination, is usually needed to confirm the diagnosis.

Treatment strategies for Baxter’s nerve entrapment focus on reducing nerve compression and inflammation. Conservative options include rest, orthotic devices to correct foot mechanics, stretching of the calf and abductor hallucis, and targeted physical therapy. Anti-inflammatory medications or corticosteroid injections may be used in persistent cases. For patients who do not respond to conservative care, surgical decompression of the nerve can be considered, which generally provides significant relief. Early recognition is important, as untreated entrapment can lead to chronic heel pain and functional limitations.

Most Useful Resources:
Baxters Nerve Entrapment (PodiaPaedia)
Baxter’s Neuritis (Medial Calcaneal Nerve Neuritis) (Podiatry Arena)
Baxter’s neuropathy secondary to plantar fasciitis (Podiatry Arena)
Baxters Nerve Entrapment (Podiatry TV)
Baxters nerve or plantar fasciitis? (Podiatry Experts)
Baxters Nerve Entrapment (Foot Health Forum)

Foot Problems in Ankylosing Spondylitis

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Ankylosing Spondylitis is primarily a problem of the spine, but the arthritis there can also cause arthritis in the foot and pain in the heel. The involvement of the spine also means the feet are going to be difficult to reach to provide self care for foot problems.

Ankylosing spondylitis (AS) is a chronic, inflammatory rheumatic disease that primarily affects the spine and sacroiliac joints. It falls under the broader category of spondyloarthropathies, which are conditions characterized by inflammation of the joints and entheses (the areas where tendons and ligaments attach to bone). The hallmark feature of AS is inflammation of the axial skeleton, leading to back pain and stiffness, which often begins in late adolescence or early adulthood. Over time, persistent inflammation can cause the vertebrae to fuse, resulting in reduced flexibility and a rigid spine.

The exact cause of ankylosing spondylitis is not fully understood, but genetic factors play a major role. A strong association exists with the HLA-B27 gene, which is found in the majority of patients, although not everyone with this gene develops the condition. Environmental triggers, such as infections, may also contribute by activating the immune system in genetically predisposed individuals. Men are more commonly affected than women, and symptoms often present gradually rather than suddenly, which can delay diagnosis.

Clinically, the main symptoms include chronic lower back pain, stiffness that improves with exercise but not with rest, and reduced range of motion in the spine. Extra-articular manifestations are also common, such as inflammation in the eyes (uveitis), cardiovascular complications, and, less frequently, lung and gastrointestinal involvement. As the disease progresses, spinal fusion can lead to a characteristic stooped posture, sometimes referred to as a “bamboo spine” on imaging studies.

Treatment for ankylosing spondylitis focuses on controlling inflammation, relieving symptoms, and preserving mobility. Nonsteroidal anti-inflammatory drugs (NSAIDs) are usually the first-line therapy, while more severe or refractory cases may require biologic agents such as tumor necrosis factor (TNF) inhibitors or interleukin-17 (IL-17) inhibitors. Physical therapy and regular exercise are critical in maintaining posture and spinal flexibility. While there is no cure, early diagnosis and appropriate management can significantly improve quality of life and slow the progression of structural damage.

Most Useful Resources:
Ankylosing Spondylitis (PodiaPaedia)
Ankylosing spondylitis (Foot Health Forum)
Heel Pain and Ankylosing Spondilitis ? (Podiatry Experts)
Impaired Gait in Ankylosing Spondylitis (Podiatry Arena)
Tarsal involvement in ankylosing spondylitis (Podiatry Arena)
Ankylosing spondylitis (Podiatry Arena)

Rupture the plantar fascia to treat plantar fasciitis

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This is something of a legend that happened in Australia where a footballer with a chronic plantar fasciitis allegedly jumped from a height in order to rupture his plantar fascia to facilitate healing. A surgical cutting of the plantar fascia is often used to treat chronic plantar fasciitis. It apparently worked.

Most Useful Resources:
Deliberate Rupture of Plantar Fascia to Treat Plantar Fasciitis (PodiaPaedia)
Rupture the plantar fascitis to help? (Podiatry Experts)
Deliberate rupture of plantar fasica to treat plantar fasciitis (Podiatry Arena)

Treatment for a plantar fascia rupture typically involves a combination of conservative measures and, in some cases, surgical intervention:

Rest and immobilization: Initially, it’s important to rest the affected foot and avoid activities that worsen the pain. Immobilization through the use of a walking boot, cast, or crutches may be necessary to allow the plantar fascia to heal.

Ice therapy: Applying ice to the affected area as soon as it happend can help reduce pain and inflammation. Ice packs or frozen water bottles can be used for 15-20 minutes several times a day.

Pain management: Over-the-counter nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen or naproxen, can help alleviate pain and reduce inflammation. Always consult a healthcare professional before taking any medication.

Physical therapy: A physical therapist may provide specific exercises to stretch and strengthen the muscles and tissues surrounding the foot and ankle. These exercises can help improve mobility, reduce pain, and promote healing.

Orthotic devices: Wearing orthotic devices, such as arch supports or custom-made shoe inserts, can help alleviate stress on the plantar fascia and provide support during the healing process.

Night splints: Night splints are devices worn while sleeping to keep the foot and ankle in a stretched position, which can help prevent the plantar fascia from tightening and promote healing.

Extracorporeal shock wave therapy (ESWT): In some cases, ESWT may be recommended. This treatment involves using shock waves to stimulate healing and reduce pain.

Surgical: If thee above conservative measure do not help, then surgery is an option.

Corticosteroid injections: Corticosteroid injections may be considered if conservative treatments are not effective. However, these injections are generally used sparingly due to potential risks.

Surgical intervention: Surgery is typically considered only when conservative treatments fail to provide relief. Surgical options may include plantar fascia release, where the tight or damaged portion of the plantar fascia is surgically cut or detached to relieve tension.

Oscon for Severs Disease

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Severs disease or calcaneal apophysitis is a common problem causing pain in the heel of kids; it is an overuse type injury to the growth plate at the back of the heel bone. It is a self limiting problem that always comes right eventually when the growth in the heel bone stops. Several treatments have been advocated for it treatment. One of these is a dietary supplement called Oscon which consists of selenium and vitamin E. It is only supported by the use of testimonials and no clinical study has been done on it. It is not clear if it is worth trying or not as most children do get the minimum dietary requirements for Vitamin E and Selenium from their normal daily intake.

The best treatment for Severs disease is generally managing the activity levels and using a cushioned heel raise.

Most Useful Resources:
Oscon Supplements for Severs Disease (PodiaPaedia)
Discussion on Oscon and Severs (Podiatry Arena)
Does Oscon work for Severs disease? (Podiatry Experts)