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Calcaneal Stress Fractures - Coggle Diagram
Calcaneal Stress Fractures
Tests
Tinel's test for nerve.
Always ask to heel raise good functional test.
Squeeze of heel bone for stress fracture.
Subjective
Pain may be localised to back and side of heel.
Insidious onset.
Common in runners and more often women from 40-60.
Typically presents with an increase in pain along side increase activity. Sudden increase in activity - overuse.
Footwear can be a key factor.
May also be attributed to a sudden change in surface i.e. treadmill to outside.
May have pain at rest.
Objective
Usually will not see swelling or bruising.
Observation: assess both alignment and gait.
Check leg length discrepancy.
Strength testing: assess both calf and glute (stability) think kinetic chain.
Palpation of tendons should not be proactive or at least not as proactive as squeeze test.
Research
Split causes into biomechanical (LLD, activity, footwear etc.) or bone health (density, nutrition).
MRI is the best at diagnosing these. Can assist with classification.
Pain free for 7-10 days before progressing to next step.
Lecture by Peter Rosenfeld (BOFAS) -
https://www.youtube.com/watch?v=C3Gtxwaollw
Diagnosis of Heel Pain Tu et al. 2011
Differentials of heel pain.
Stress fracture patterns.
Good tables/ images consolidating conditions.
Why this and nothing else?
Squeeze test of heel.
Consider location of tenderness.
Think overuse/ change in load profile.
Differentials
Achilles tendinopathy
Retro calcaneal bursitis
Calf pathology
Plantar facitis
Tarsal tunnel syndrome
Pathology
Occurs due to increase activity on normal bone or normal loading on weakened bone.
Overuse injury associated with increased volume or intensity of training workload.
Treatment
After allowing heeling process to take place slow reintroduction into activity.
Activity cessation with rest and protection. Boots can be used.
Very much guided by pain (7-10) days.
Off load and avoid impact activity move to bike etc. Then progressive to walking treadmill...