I recently had a patient in my office who had a complaint of posterior heel pain when wearing several different pairs of dress shoes. He had a fairly large retrocalcaneal exostosis on the right calcaneus at the proximal aspect of the posterior calcaneus.
There are obviously a number of ways to address the retrocalcaneal exostosis. Our primary goals are to reduce pressure and reduce friction. Reducing pressure in this area is always a little tough without changing shoes. Although you can attempt to stretch shoes in this area, it is usually not particularly effective.
Clinicians can control friction in a couple of different ways. Orthotic devices can be helpful for limiting calcaneal motion. This patient was already wearing orthotic devices that are very controlling so we have already eliminated any excessive motion that might be contributing to his symptoms.
We can also reduce friction locally with the PTFE Patch™. PTFE (polytetrafluoroethylene) is a new orthotic and shoe modification material with an extremely low coefficient of friction (COF) of approximately 0.16. Typical shoe materials and orthotic top covers have a COF in the 0.5 to 0.6 ranges. PTFE is also unique in that it is the only material used in shoe and orthotic manufacturing that does not have an increased COF when it becomes wet.
PTFE is available as a self-adhesive patch that clinicians can apply locally in areas where there is excessive friction that leads to pain, callus, ulcer or blister formation.
In this case, I applied a large oval PTFE Patch to the back of the shoe. I then had the patient wear the shoe and walk up and down the hall. He had almost complete pain relief with application of the patch.
This is a good example of how to use friction management to help treat posterior heel pain.
Editor’s note: Dr. Huppin is the Medical Director of ProLab Orthotics, the distributor of the PTFE Patch™. This blog was originally published at http://www.prolaborthotics.com/Blog/tabid/90/EntryID/474/Default.aspx  and has been adapted with permission from Lawrence Huppin, DPM, and ProLab Orthotics. For more information, visit www.prolaborthotics.com  .