1. Achilles Pain
A. <16-year-old – Sever’s disease
Intro: Sever’s disease involves irritation of the growth plate on the backside of the heel bone. This is often a due to overuse especially in young athletes.
Symptoms: Pain on the back of heel bone especially on activity use.
Treatment: Rest, ice, activity modification, physical therapy especially stretching the Achilles tendon, or use of heel cups/pads. Symptoms typically resolve once growth plate closes.
B. >18-year-old – Achilles tendonitis
Intro: Achilles tendonitis involves irritation of the Achilles tendon, which attaches the calf muscle onto the heel bone. Overuse or a tight tendon are common contributors to this condition.
Symptoms: Pain on the back of heel bone especially on activity use.
Treatment: Rest, ice, activity/shoe modification, physical therapy especially stretching the Achilles tendon, or use of heel cups/pads. Regenerative treatment such as plasma rich platelet (PRP) injection, which promotes healing of the tendon is sometimes considered for this condition. Operative modalities are considered in refractory cases.
2. Posterior tibial tendon insufficiency
The tibialis posterior is a muscle that runs on the inner side of the lower leg. When the tendon becomes insufficient to support the ankle, pain along with deformity of the arch of the foot (flat foot) may occur. This condition may occur with increased age or injury. It is recommended to seek medical attention as soon as possible for this condition to prevent worsening.
3. Ankle osteoarthritis
Intro: Osteoarthritis of the ankle is a degenerative joint disorder that may manifest the elderly naturally or in individuals with prior injury.
Symptoms: Pain and decreased motion of the ankle.
Treatment: Physical therapy, and medications. A steroid injection may help provide relief. Surgical management may be considered in refractory cases.