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Wednesday, October 5, 2011

Heel Pain: Perhaps It Is Not Always Related to Pronation

These are 2 old inserts of mine clearly demonstrating that I pound my heels. See the Wear and Tear in the heel area right greater than left indicating excessive heel pressures. I love when patients bring in old orthotics, even old shoe inserts, so I can get a good picture as to their biomechanics. With the way I pound my heels, if I get heel pain, I better find a way to cushion them.

 So my last patient today, October 5th, 2011 had 3 years of heel pain and relatively excessive pronation (moderate at best). Three pairs of orthotics from different podiatrists, 3 cortisone shots, a night splint, some xrays and a right MRI (his worse side) failed to give him any relief or understanding of his problem. The following plastic based orthotic devices are representative of the pair he had, but even harder plastic posts.
 When evaluating his gait, I felt that his pronation was well controlled, but that his heel strike was very hard. I had first observed that part watching him initially walk barefoot. Then he failed the big question: Do you feel that the heel is being suspended (protected) and the pressure is being transferred to the arch? His answer was "no" and even thought the pronation looked well controlled he felt no pressure in the arch from the orthotic device.

I rectified that immediately by completely removing the heel posts, thinning all the plastic under the heel to almost nothing, adding 3 layers of 1/8th inch neopreme padding (2 on top of the heel cup, and 1 below), and adding arch reinforcement. When I asked again the same question, the smile on his face was something to behold!! I will probably end up redoing the orthotic devices, but for today I was trying to see why his "good stabilizing" orthotic devices were not helping. No one looked at the force of his heel strike.
 This represents the heel padding used to cushion the force at heel strike.

 Here are the famous blue dots to add heel cushion before placing on the topcover of an orthotic device.

Here is the schema I was for watching foot motion. The green is considered normal. The "loud or hard heel strike" observation for Kirk was crucial today to finding the why of his 3 years of heel pain. Gait evaluation wins again (at least another small battle, one day at a time).

I think this emphasizes that with heel pain, just controlling pronation is not always right, just cushioning the heel is not always right, but a combination of the two is crucial.

1 comment:

  1. Heel cushions are effective for people with heel pain. These cushions help lessen the impact of weight incurred when walking or climbing down a ladder.

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.