Overload Heel Pain Syndrome

Overload Heel Pain Syndrome Overview

Overload heel pain syndrome is repetitive trauma induced condition. Overload heel pain syndrome causes pain that is centrally located in the heel rather than towards the inside of the heel pad, which typical in plantar fasciitis. Individuals with high arched feet, weakness of the calf muscle or Achilles tendon dysfunction are more prone to overloading the heel with resulting symptoms. In addition, thin soft tissue padding (fat pad atrophy) can cause overload heel pain syndrome.

How is Overload Heel Pain Syndrome Diagnosed

Diagnosis is usually based on patient history and clinical examination

Clinical Presentation of Overload Heel Pain

Patients with overload heel pain syndrome have symptoms of pain directly to central portion of the heel. Most heel pain is related to plantar fasciitis. In overload heel pain syndrome, essentially the soft tissues and bone directly under the heel bone (calcaneus) are aggravated by direct repetitive pressure from standing and walking. Factors which predispose an individuals to overload heel pain syndrome include:

  • obesity
  • a prominent heel
  • thin tissue / skin overlying the heel bone (fat pad atrophy)
  • certain foot shapes (ex. high arched foot)

Physical Examination

  • Localize the tenderness centrally in the heel pad.
  • Patient may have increased ankle dorsiflexion (the ability to move the foot up towards the shin) which makes the heel more prominent (calcaneal gait)
  • Excessive weight may also be present.

Imaging Study

  • X-ray are taken to rule out any other pathology
  • X-ray may show a heel spur to the bottom of the heel bone
  • An MRI may show an increase area of bone bruising (increased signal to the heel bone)
  • An MRI may show a bursa (fluid filled sac) to bottom of the heel
  • An MRI may show decreased fat pad

Treatment of Overload Heel Pain Syndrome

Non-Operative Treatment

This is the most common treatment option, which involved protecting the area from repetitive trauma,  This can be achieved by limiting walking, standing.  In most cases, immobilization with cam boot / cam walker may be used for a short period of time.  If fat pad atrophy is a concern, protecting / cushioning the area is recommended.

Surgical Treatment

Surgical treatment is uncommon but in severe cases, it may be necessary.  Surgical treatment may include removing bone spur, tightening the Achilles tendon or reconstructive foot surgery to reduce the pressure on the heel bone.

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