Conquering Posterior Heel Pain In Athletes

By Christopher R. Corwin, DPM, MS, and David C. Erfle, DPM

    Americans of all ages are participating in athletic activities, including football, at a higher level than ever before. Unfortunately, this also leads to an increased incidence of injury. Heel pain is a common complaint among athletes. It can be particularly disabling and result in a loss of playing time.

    Heel pain comes in many forms: plantar fasciitis, Baxter’s neuritis, tarsal tunnel syndrome, calcaneal apophysitis, Achilles tendonitis, bursitis, calcaneal stress fractures and contusions. Typically, it is a combination of these that causes pain and discomfort.

    With the return of high school athletes to two-a-day practices in the fall season, many experience some form of heel pain. One must consider multiple factors when treating athletes. Clinicians should determine if the athlete is currently “in season” or is in the “off-season.” Taking a considerable amount of time off during the season is simply not an option for many athletes. Professional athletes are paid to play and perform while college and high school athletes may have scholarship considerations. Not to be overshadowed are the millions of recreational athletes who are training for events that are just as important to them as the professional games. Athletes in the off-season may have more time to rest and rehab the injury.

    Podiatrists should also consider the competitive level of the athlete. High school, college and professional athletes may have better access to athletic trainers, physical therapy and rehabilitation services than the layperson. Ultrasound, electrical stimulation, iontophoresis and deep tissue massage are powerful healing tools, but not every athlete has access to these on a daily basis. Therefore, recreational or weekend athletes may have to do more of their rehab on their own at home. Regardless of the season or level of involvement, modification of activity is the key component to treatment.

    There are many other factors to consider when treating the athlete. Does the athletic schedule permit time to cross-train or attain relative rest? Exercise bikes, elliptical trainers and pool running may help to maintain cardiovascular fitness while reducing stress on the injured area. What is the athlete able to do off the field? Can he or she be immobilized in a CAM walker or surgical shoe for the 22 hours a day that he or she is not playing? Can the athlete tolerate a night splint to help with stretching? Is he or she able to warm down properly and use ice after activity? Can the athlete tolerate antiinflammatory medications, steroidal or nonsteroidal?

Why Shoe Gear Plays A Critical Role

    Shoe gear also plays an important role in the athlete with heel pain, particularly with football players. Shoes should match the conditions and the playing surface. For example, at every game, the athlete should have three pairs of shoes: molded cleats, turf shoes and flats/sneakers.

    Synthetic turf fields are becoming more common at high schools and colleges across the country. The new synthetic turf fields are no longer the thin carpet on a slab of concrete from years ago. Many have enhanced cushion and synthetic blades that match the length and feel of natural grass. However, all of the synthetic fields are not equal. Some fields with higher synthetic grass blades may have too much grip with turf shoes. This does not allow the shoe to release during cutting maneuvers, thereby causing increased transverse plane torque on the ankle and knee. Unfortunately, this all too often results in serious injury. Other fields may be too slippery for typical molded cleats while others require sneakers or “flats.”

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