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RETROCALCANEAL PAIN: A FOCUS ON RETROCALCANEAL PAIN

Treatment for retrocalcaneal bursitis starts with the basis of treating the inflammatory process.  Activities that irritate the posterior heel should be avoided, and replaced with alternative activity such as swimming and barefoot activity.  Typically, twice per day, cryotherapy of the area and oral NSAID are recommended.  Topical NSAIDs such as diclofenac are also an option for those patients who have issues with oral NSAIDs.  Some clinicians choose to immobilize a patient after injection for five to seven days as a precautionary measure to protect the Achilles tendon after steroid injection.

The pathoigenesis of tendinopathy is thought to ensure because of micro-tears in the tendon fibers, which then cause a release of molecules including inflammator cytokines acting as disease mediators and neural ingrowth accompanies the angiogenesis.  There is tenderness with palpation of the tendon and even some crepitus.  Chronic Achilles tendinopathy is thought to accompany calcifiction of the tendon and is termed Achilles insectional clacific tendinopaty. There is usually a gradual onset of pain over a period of weeks or even months. Patients often complain of pain and stiffness in the chilles tendon, especially in the morning or after rest.  In cases proximal to the insertion are tender with palpation and have overlying edema.

Over-training factors can contribute to the development of both acute and chronic conditions such as distance, speed, or hills.

Typically, a heel lift of 5/16" to 7/16" in a removable walking cast boot can alleviate tension on the tendon.  Beginning physical therapy for soft tissue mobilization stretching of the gastroc-soleal complex, therapeutic modalities such as ultrasound and electric stimulation can be helpful.  A night splint and home passive and active stretching program as well as strengthening should be incorporated.

Surgical Treatment

Radio-frequency ablation techniques and/or debidement of the Achilles tendon may be employed if conservative care fails.  In the literature, a variety of techniques are described with most favoring complete decompression of the retrocalcaneal space including resection of the bursa, bone eminence, scarred paratendon and tendon including any calcification.  Yodlowski et al. evaluated 35 patients (41 feet) who had painful Achilles tendon syndrome and with a follow-up of 20 months, ninety percent of patients had complete or significant relief of symptoms. Recovery may take up to one year.

Platelet Rich Plasma (PRP

Neo-vascylarization with angiogenesis promote tenocyte growth and show over expesssion in the epitenon with more rapid tendon healing.  Other articles have expressed that PRP may not have an effect on healing of acute Achilles tendon rupture.  Thus, the use of PRP may be more appropriate in chronic degenerative tendinopathy.  Often it is a technique that can be preformed under local anesthesia in the office  percutaniously or in the operating room.

These two etiologies of retrocalcaneal pain can often be dfficult to treat in the active patient.

 

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501 Hospital Lane, Room 201
Terre Haute, IN 47802
812-478-5145 fax 812-232-7301

7962 Oaklandon Road, Suite 114
Indianapolis, IN 46236
317-472-0826 fax 317-472-0829


Podiatrist Terre Haute, IN - Allied Podiatry, 501 Hospital Lane, Terre Haute, IN, 47802 812-478-5145 || 7962 Oaklandon Road Suite 114, Indianapolis, IN 46236 317-472-0826

  The podiatrist at Allied Podiatry treat foot and ankle problems such as heel pain, diabetic foot care, bunions and shockwave therapy in Terre Haute, IN. Dr. Hilaire is Board Certified and licensed podiatrist in the state of Indiana.