"How I Approach Problems": Heel Pain, Sudden Onset, Swelling

    This is a new series of blog posts on various injuries entitled "How I Approach Problems". I will be going through common injuries to start and then the areas that prove more complex challenges. I hope my thought process will help you if you are treating this injury or have this injury or injured area.

With the description of heel pain, sudden onset (you can remember the day), and swelling, you are not dealing with plantar fasciitis, but either a heel bone stress fracture or plantar fascial tear. The post today will look at the calcaneal (heel) stress fracture and the thought process in treatment. 

In the 2 MRIs above, the patient's sudden heel pain with swelling was diagnosed as a calcaneal (heel bone) stress fracture. The xrays taken the week before were completely negative. This case completely resolved with the repeat MRI 6 months later.
     When you talk about any stress fracture, or gross fracture for that matter, you have to ask yourself if the patient deserved the fracture by how they treated their foot. By this I mean, did they seem to overdo or over stress the foot, and seemed to get what they deserved. If your answer is no, then you have to look for other reasons a bone would break like low Vitamin D, low bone density, eating disorders, celiac's disease, history of osteoporosis, etc. Even if they seem to deserve it, over 50 years old, I get a bone density, and ask about family history of osteoporosis, and a personal history of low Vitamin D or funny diets.
     I am going to attach the original video I did on heel pain so you can see the examination of someone pointing to a heel stress fracture. Heel stress fractures are treated very differently than plantar fasciitis as the patient was initially diagnosed due to heel pain. Heel stress fractures need soft cushions, perhaps custom Hannaford orthotic devices, bone density and Vitamin D blood levels, possible bone stimulator, and occasionally they break all the way through and need some surgical pinning. Making the correct diagnosis at the beginning of the process saves alot of time.

https://youtu.be/plbBvPASXwM