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Common biomechanical diagnosis for difficult to treat heel pain?

Posted by Nanafitz on 8/31/00 at 09:57 (026808)

Hi Dr. Z. I've followed, with interest, your info, comments, and suggestions since I found this site at the beginning of the summer. I just saw a biomechanical podiatrist here on Long Island (after seeing 4 podiatrists, 1 ortho, 1 chiropractor, and 1 rheumatologist). It seems that my heel pain keeps coming back due to a condition known as forefoot equinus disorder. Are you familiar with this, and is it possible that this condition is inherant to many of us on this board who suffer with unresolved heel pain? I just received the results of everything he found, and will be seeing him again next week to talk about it. Any info you could post might be helpful to others who are suffering from this debilitating (physical and psychological) pain......thank you.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Zuckerman on 8/31/00 at 16:51 (026831)

. The achilles tendon is short or tight. The foot is usually a typical high arched foot which is either rigid or flexible. The problem with this foot type is that a rigid biomechanical orthosis usually makes this foot type worse due to the lack of necessary pronation . This is different that abnormal pronation . So what to do with we this foot. If you are having first step in the morning pain, and orthosis didn't help I would performed a minimial incisoin partial plantar release. Do you have pain in the ball of the foot. Did you have hammer toes. If you don't have the am first step pain then an accomdative orthosis should be used. If you are having alot of pain in the heel and the ball of the foot with hammer toe deformity then a reconstruction of this foot type will have to do consider. With the right orthosis the problem can be helped.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Zuckerman on 8/31/00 at 16:54 (026832)

Dr. Biehler is a biomechanical expert. I would like his imput in this condition. Thanks.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Biehler on 8/31/00 at 19:21 (026840)

Equinus is very common and probably causes most of the achillies problems. Forefoot equinus is not that common and implies that the foot is plantarflexed at the midtarsal joint. What this mean is that when the heel is at 90 degrees to the leg, the front part of the foot drops down to a lower postion. Putting a foot like this flat on the ground has the effect of doriflexing the ankle which tightens the achillies even when standing still. Acommodating for this can involve using heel lifts to take pressue off the achillies durring gait. I am glad you found a good biomechanicaly inclined Doctor. Dr. Biehler

Re: Common biomechanical diagnosis for difficult to treat heel pain?

john a on 9/01/00 at 07:33 (026868)

'Nanafitz', do you like the biomech pod you're seeing on Long Island? I'm in the market for one myself, so if so, could you please post his name and town? Thanks much.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Nanafitz on 9/04/00 at 20:22 (027182)

Hi John a.......the biomechanical specialist I saw is Jeffrey Cusack DPM, E. Northport, NY. 1-631-266-2220. I saw him only once so far, and I have no basis for comparison. I liked him very much, though. The exam was extensive and I got a copy (> 10 pages) of the report that he sent to my referring podiatrist. I didn't understand a lot of it, but I see him tomorrow so my list of questions is long. Good luck!

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Zuckerman on 8/31/00 at 16:51 (026831)

. The achilles tendon is short or tight. The foot is usually a typical high arched foot which is either rigid or flexible. The problem with this foot type is that a rigid biomechanical orthosis usually makes this foot type worse due to the lack of necessary pronation . This is different that abnormal pronation . So what to do with we this foot. If you are having first step in the morning pain, and orthosis didn't help I would performed a minimial incisoin partial plantar release. Do you have pain in the ball of the foot. Did you have hammer toes. If you don't have the am first step pain then an accomdative orthosis should be used. If you are having alot of pain in the heel and the ball of the foot with hammer toe deformity then a reconstruction of this foot type will have to do consider. With the right orthosis the problem can be helped.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Zuckerman on 8/31/00 at 16:54 (026832)

Dr. Biehler is a biomechanical expert. I would like his imput in this condition. Thanks.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Dr. Biehler on 8/31/00 at 19:21 (026840)

Equinus is very common and probably causes most of the achillies problems. Forefoot equinus is not that common and implies that the foot is plantarflexed at the midtarsal joint. What this mean is that when the heel is at 90 degrees to the leg, the front part of the foot drops down to a lower postion. Putting a foot like this flat on the ground has the effect of doriflexing the ankle which tightens the achillies even when standing still. Acommodating for this can involve using heel lifts to take pressue off the achillies durring gait. I am glad you found a good biomechanicaly inclined Doctor. Dr. Biehler

Re: Common biomechanical diagnosis for difficult to treat heel pain?

john a on 9/01/00 at 07:33 (026868)

'Nanafitz', do you like the biomech pod you're seeing on Long Island? I'm in the market for one myself, so if so, could you please post his name and town? Thanks much.

Re: Common biomechanical diagnosis for difficult to treat heel pain?

Nanafitz on 9/04/00 at 20:22 (027182)

Hi John a.......the biomechanical specialist I saw is Jeffrey Cusack DPM, E. Northport, NY. 1-631-266-2220. I saw him only once so far, and I have no basis for comparison. I liked him very much, though. The exam was extensive and I got a copy (> 10 pages) of the report that he sent to my referring podiatrist. I didn't understand a lot of it, but I see him tomorrow so my list of questions is long. Good luck!