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Sunday, February 28, 2021

Heel Pain Overload Syndrome Review

The following comment was placed on my You Tube video today on examination of heel pain.

Dear Dr. Blake:
I was diagnosed with heel pain overload syndrome by an orthopedic surgeon. How do you treat that condition? pain is more on the outside bottom of the foot, and same area at the heel.

Dr. Blake's comment: Thank you for your comment. This is a new diagnosis label I have been seeing lately. The diagnosis implies the heel itself is overloaded or overwhelmed by the stress asked of it and soft tissue injury occurs. The attached link here reviews this problem.

In my video above, I point out the areas of pain other than plantar fasciitis (the most common cause of heel pain). Heel Pain Overload Syndrome is a syndrome since the same overload can cause multiple injuries: heel bursitis (both superficial and deep), deep heel bone bruising (MRI diagnosis), plantar nerve entrapment (Baxter's neuropathy), and heel stress fractures (again usually only seen on bone scans and MRIs).

The following photos should give you an impression of the treatments. On my blog, type heel pain in the search engine and start reviewing other links. I hope this helps. Rich

The patient has to decide with immersion in ice water for 10 minutes or a 5 minute frozen sports bottle ice massage feel better.

With heel overload syndrome, there is a role both for heel pads for straight cushion, arch supports to transfer the weight off the heel and into the arch, and entirely soft based orthotics which do both. The above are unfinished Hannaford soft orthotic devices runners wear.

Here I have added a soft rim to an orthotic to take pressure off the bottom surface

Why do you develop this? What is the Root cause? That should be investigated so this does not happen again! Is it a poor fat pad, high arches with a prominent heel, over striding with running and slamming the heels down too hard, poor padding in the shoe choice, etc, etc.

I love support the foot tape, at least one application to rule out plantar fascia symptoms. Buy at

This emphasizes that it is the transference of weight into the arch that typically is more important than heel cushions. But it is good to try both.

We can not forget the nerves that can get locally irritated, or the irritation is in the back or another part of the spine and the symptoms just present at the heel. Of course, combinations of the two exist called "Double Crush Syndrome". Yes, another syndrome.

An MRI image of the side of the heel showing intense inflammation of the bottom one third of the heel (all white and it should be dark). This was ruled a stress fracture and needed 3 months in a walking boot.
In this walking boot, since there was still heel pain in the boot, I applied 1/2 inch adhesive felt to float the heel 80% which really helped.

Here I have customized a pair of Sole OTC inserts by adding as much arch as the patient can tolerate.

And softening the heel with first grinding out the hardness of the red material, and then adding a 1/8 inch heel cushion.

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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.