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Location of heel pain

Posted by BrianJ on 6/14/01 at 22:03 (050727)

My heel pain (bilateral) is just forward of the calcaneus, and slightly to the lateral side of the foot's midline. Given that I do not have the 'classic' medial-side pain, should my orthotics or stretching be different than the norm? I know this sounds like a strange question, but two years of various orthotics and stretching (and many other treatment modalities) have not helped me, and I'm trying to figure out why.

Re: Location of heel pain

josh s on 6/14/01 at hrmin (050735)

Brian, I'm not a doctor but have similar symptoms, so I'll share what I've learned, possibly of help. Scott, in his book, mentioned that some people have sprained their calcaneocuboid or plantar ligaments. He mentions that the treatment for this is similar to treatment for pf. I would agree, particularly improving ankle flexibility and countering hyperpronation, either with orthotics, taping, etc will help, though it sounds like you've got all that.

The plantar ligaments originate deep under the heel and attach on the cuboid and bases of the lesser metatarsals. The cuboid is just in front of the heel bone on the lateral side and is considered the 'key stone' of the lateral arch. While weightbearing, this bone 'locks' into it's articulation with the heel bone, enabling the lateral arch to become a rigid lever for efficient propulsion while walking. This locking mechanism is reinforced by the plantar ligaments which are very strong.

In people who overpronate while walking, frequntly their mechanics does'nt allow for this 'locking' to take place, in which case the plantar ligaments are subjected to forces for which they were not designed. Orthotic devices are typically designed to not only counter excessive pronation but also to assist this locking mechanism. It is my understanding that even while locked this joint (the calcaneocuboid) and it's ligaments may be strained, particularly if you lack flexibility in your ankles. I have read mention of strain to the plantar ligaments in connection to falling arches (severe pronation)- in which the strain is repetitive and also in connection to a direct trauma or accident which would be called a sprain.

I sprained these ligaments in my right foot and began to experience instability and pain in the region. My podiatrist diagnosed it as a 'subluxed cuboid' which means that the cuboid is dropping down toward the ground, which should ordinarily be prohibited by tension in the plantar ligaments. This is usually treated with a cuboid pad placed underneath the area, designed to support and coax the cuboid back into it's proper place.

If your pain is deeper than plantar fasciitis pain typically is and more on the lateral side of the foot, as mine is, you may be feeling pain from these ligaments.

Again, I am not a doctor and there may be other reasons for your pain, hopefully one of the doctors can give you further info and advice.

As far as orthotics goes, I recently received a pair of 'retainer' orthotics from afo-lab (afo-lab.com) which uses a biomechanical model that places special emphasis on the integrity of the lateral arch and these ligaments. This 'retainer' uses a concept and method of repositioning this area and claims to be the only device capable of reversing hypermobility. I've only had them for a couple of weeks and can't say much but that they definately support this area and feel quite a bit different than the classic podiatric orthotic. You might want to visit their site and read the articles on human locomotion and also on repetitive strain injury. My podiatrist prescribed them on my request, the only independant opinions on them that I've received was from a heelspurs poster, bg cped (a pedorthist) who denounced them as being seriously flawed, though he never clarified exactly why, and another pedorthist who looked at them, shrugged and said he did'nt think anyone had really figured out the whole foot picture yet, and that there were many schools of thought in the orthotic world. If you'd like to research this product, search Google under retainer orthotic jack glick (the inventor), there are some interesting letters on a podiatry site that you'll find. Hope this helps.

Re: Location of heel pain

john h on 6/18/01 at 12:35 (050957)

barbara showed me her birks and the foot impression that had been made for the years she has been wearing them. one foot had what i would call a normal heel impression and the other foot/heel was significantly smaller. she thinks and it makes some sense that she is putting most of her weight on the one foot. definitely a big difference. if one leg was slightly shorter than the other would this create this type of impression dr Z?

Re: HEEL SPURS

SANDRA T on 6/19/01 at hrmin (051035)

HAVE HAD PAIN IN MY LEFT FOOT FOR 8 YEARS BUT RECENTLY HAVE WORSENED THIS PAST YEAR AND JUST RECEIVED THE RESULTS FROM X-RAY AND THEY HAVE TOLD ME I HAVE PLANTAR BONE SPURS. WHAT I EXPECT FROM MY FIRST VISIT TO THE PODIATRIST UPON MY SCHEDULED APPOINTMENT..

Re: Location of heel pain

josh s on 6/14/01 at hrmin (050735)

Brian, I'm not a doctor but have similar symptoms, so I'll share what I've learned, possibly of help. Scott, in his book, mentioned that some people have sprained their calcaneocuboid or plantar ligaments. He mentions that the treatment for this is similar to treatment for pf. I would agree, particularly improving ankle flexibility and countering hyperpronation, either with orthotics, taping, etc will help, though it sounds like you've got all that.

The plantar ligaments originate deep under the heel and attach on the cuboid and bases of the lesser metatarsals. The cuboid is just in front of the heel bone on the lateral side and is considered the 'key stone' of the lateral arch. While weightbearing, this bone 'locks' into it's articulation with the heel bone, enabling the lateral arch to become a rigid lever for efficient propulsion while walking. This locking mechanism is reinforced by the plantar ligaments which are very strong.

In people who overpronate while walking, frequntly their mechanics does'nt allow for this 'locking' to take place, in which case the plantar ligaments are subjected to forces for which they were not designed. Orthotic devices are typically designed to not only counter excessive pronation but also to assist this locking mechanism. It is my understanding that even while locked this joint (the calcaneocuboid) and it's ligaments may be strained, particularly if you lack flexibility in your ankles. I have read mention of strain to the plantar ligaments in connection to falling arches (severe pronation)- in which the strain is repetitive and also in connection to a direct trauma or accident which would be called a sprain.

I sprained these ligaments in my right foot and began to experience instability and pain in the region. My podiatrist diagnosed it as a 'subluxed cuboid' which means that the cuboid is dropping down toward the ground, which should ordinarily be prohibited by tension in the plantar ligaments. This is usually treated with a cuboid pad placed underneath the area, designed to support and coax the cuboid back into it's proper place.

If your pain is deeper than plantar fasciitis pain typically is and more on the lateral side of the foot, as mine is, you may be feeling pain from these ligaments.

Again, I am not a doctor and there may be other reasons for your pain, hopefully one of the doctors can give you further info and advice.

As far as orthotics goes, I recently received a pair of 'retainer' orthotics from afo-lab (afo-lab.com) which uses a biomechanical model that places special emphasis on the integrity of the lateral arch and these ligaments. This 'retainer' uses a concept and method of repositioning this area and claims to be the only device capable of reversing hypermobility. I've only had them for a couple of weeks and can't say much but that they definately support this area and feel quite a bit different than the classic podiatric orthotic. You might want to visit their site and read the articles on human locomotion and also on repetitive strain injury. My podiatrist prescribed them on my request, the only independant opinions on them that I've received was from a heelspurs poster, bg cped (a pedorthist) who denounced them as being seriously flawed, though he never clarified exactly why, and another pedorthist who looked at them, shrugged and said he did'nt think anyone had really figured out the whole foot picture yet, and that there were many schools of thought in the orthotic world. If you'd like to research this product, search Google under retainer orthotic jack glick (the inventor), there are some interesting letters on a podiatry site that you'll find. Hope this helps.

Re: Location of heel pain

john h on 6/18/01 at 12:35 (050957)

barbara showed me her birks and the foot impression that had been made for the years she has been wearing them. one foot had what i would call a normal heel impression and the other foot/heel was significantly smaller. she thinks and it makes some sense that she is putting most of her weight on the one foot. definitely a big difference. if one leg was slightly shorter than the other would this create this type of impression dr Z?

Re: HEEL SPURS

SANDRA T on 6/19/01 at hrmin (051035)

HAVE HAD PAIN IN MY LEFT FOOT FOR 8 YEARS BUT RECENTLY HAVE WORSENED THIS PAST YEAR AND JUST RECEIVED THE RESULTS FROM X-RAY AND THEY HAVE TOLD ME I HAVE PLANTAR BONE SPURS. WHAT I EXPECT FROM MY FIRST VISIT TO THE PODIATRIST UPON MY SCHEDULED APPOINTMENT..