Chronic heel pain

1 Achilles tendinopathy

(previously named Achilles tendinitis, but it was wrong)

This is a breakdown in the Achilles tendon, with small, focal lesions within the tendon without an inflammatory response. It is a long-term condition with degenerative change inside of the tendon

MRI scan show degenerative Achilles tendon

Signs and symptoms:

• A persist pain around heel and calf region, normally pain appears “U” shape, it means pain before and after the activity, usually decreased within the activity.
• But in the worsen case, it can be constant pain through the activity.
  

Treatments:

• The best evidences show a prolonged physiotherapeutic exercise is the best way to manage this problem; it should be progressed under physiotherapist’s supervision.
• Some other pain managements, such as acupuncture, taping, Deep tissue massage, ice and TENs may decrease the pain temporarily.

Prognosis:

• In general, the prognosis is good; most of people recover under few weeks exercise program plus pain management. Very few people have to go for surgery.

2 plantar fasciitis
It is the injury in plantar fascia; a connective tissue runs between heel bone and metatarsal bones.

This problem is result from abnormal foot arch and high tension in plantar fascia.

Signs and symptoms:

• A patient with plantar fasciitis may have pain anywhere along the course of the plantar fascia but most commonly where the fascia joins the bottom of the heel bone.
• The patient often feels a great deal of pain after resting, particularly when placing weight on the foot first thing in the morning.
• It may be combined heel spur.

Treatments:

• stretch, taping, foot orthosis will help, in addition, acupuncture, deep tissue massage also can relief the pain.