Heel Pain: When the Plantar Fascia is Not Involved

Swollen Left Heel on MRI showing Good Robust Plantar Fascia that I thought may be torn

The cause of the pain is an infra calcaneal bursae or bursitis. See the Black lump under the plantar fascia and pushing the normal fat out of the way.

Treatment of this Subcalcaneal Bursitis with be ice massage, off weighting the heel for awhile, very soft cushioning around the heel while cooking and prolonged standing, soft Hannaford based orthotic devices, and PT to try to drive out the inflammation with ultrasound, soft tissue mob, and electric stim and ice.

Calcaneal Stress Fracture: Last Patient of 2019

     My last official patient of 2019 was the 95 year old mother of a wonderful patient of mine. He brought her into the treatment room in a wheelchair with acute one day pain in her right heel. There was no incident of trauma. She has been struggling with pain in her left knee for a long time and perhaps is favoring her right foot. I went right to an MRI which they were able to get within the hour at our hospital fearing broken bone with this age and history until proven otherwise. Xrays can take weeks show subtle signs of a stress fracture, but the MRI images below (both T1 and T2) dramatically show the stress fracture non-displaced. I will keep her off her foot for the next month and start an Exogen bone stimulator if I can get approval for. Interestingly, her son fractured his heel bone doing ball room dancing 10 years ago in the same place. Genetic do give us weak spots. You can tell by the MRIs that the stress fracture was not due to weight bearing compression forces, but to the pull of the achilles tendon similar to many cases of Severs. Look how strong the achilles looks and the overall bone density seen on T2 throughout the area looks fine and not demineralized like in disuse atrophy. 

On a side note: This is my 2000th Blog Post since my start of blogging in March 2010! No one cares but me, but that will not stop me from raising a glass of champagne or bubbly tonight! Happy New Years.