What is the treatment for calcaneus pain affecting range of motion (ROM)?

Treatment of Calcaneus Pain Affecting Range of Motion

For calcaneus pain limiting ROM, initiate functional treatment with early mobilization, stretching exercises, NSAIDs, and orthotic support while avoiding complete immobilization, as this approach provides the fastest return to function and prevents muscular atrophy. 1, 2

Initial Diagnostic Considerations

Before treating, identify the specific cause of calcaneal pain through targeted examination:

• Palpate specific anatomical landmarks: Check the Achilles insertion, posterior superior calcaneus, lateral calcaneal wall, and medial plantar heel to localize pathology 1
• Perform calcaneal compression test: Squeeze the calcaneus medially to laterally—pain suggests stress fracture 1
• Assess pain patterns: Morning pain with first steps indicates plantar fasciitis; posterior pain with shoe pressure suggests Haglund's deformity with bursitis; progressively worsening pain after activity change suggests stress fracture 1, 2
• Re-examine at 3-5 days post-injury if acute trauma occurred, as initial swelling can obscure findings 1

Treatment Algorithm Based on Diagnosis

For Plantar Fasciitis (Medial Plantar Heel Pain)

• Begin regular calf-muscle stretching and plantar fascia stretching exercises as the cornerstone of treatment 2
• Apply cryotherapy and modify activities to reduce inflammation 2
• Provide over-the-counter heel cushions and arch supports immediately 2
• Prescribe NSAIDs (ibuprofen 400 mg every 4-6 hours as needed for pain relief) 2, 3
• Avoid flat shoes and barefoot walking to prevent symptom exacerbation 2
• Consider corticosteroid injections if conservative measures fail after 6 weeks 2
• Add night splinting or customized orthotics for refractory cases 2

For Insertional Achilles Tendinopathy (Posterior Heel Pain)

• Recommend open-backed shoes immediately to eliminate pressure on the insertion 2
• Provide heel lifts or orthoses to reduce tendon strain 2
• Prescribe NSAIDs for pain and inflammation (ibuprofen 400 mg every 4-6 hours) 2, 3
• Initiate stretching exercises focusing on the Achilles tendon 2
• Decrease activity level temporarily 2
• NEVER inject corticosteroids near the Achilles tendon due to rupture risk 2

For Haglund's Deformity with Retrocalcaneal Bursitis

• Switch to open-backed shoes to eliminate posterior pressure 2
• Apply orthoses with accommodative padding lateral to the Achilles 2
• Prescribe NSAIDs for acute inflammation 2
• Consider corticosteroid injections into the bursa (avoiding the Achilles tendon itself) 2
• Refer to physical therapy for targeted treatment 2

For Calcaneal Stress Fracture

• Protect and immobilize the foot immediately 1
• Obtain radiographs initially, but recognize symptoms often precede radiographic findings 1
• Order technetium bone scan or MRI if radiographs are negative but clinical suspicion remains high 1
• Eliminate weight-bearing activities until healing occurs 1

Critical Management Principles for ROM Restoration

In cases of ROM restriction, mobilization therapy combined with exercise therapy is essential—mobilization alone is insufficient. 4

• Avoid complete immobilization as it causes muscular atrophy and deconditioning, worsening ROM deficits 2
• Limit immobilization to 3-5 days maximum for acute injuries with severe pain/swelling, then commence active exercise 4
• Use semirigid braces over tape for functional support during rehabilitation, as braces are more cost-effective 4
• Initiate early weight-bearing as tolerated to facilitate faster recovery 4

Referral Indications

Refer to podiatric foot and ankle surgery if:

• No improvement after 6-8 weeks of appropriate conservative treatment 1, 2
• Advanced imaging is needed (MRI, bone scan) for diagnostic clarification 1
• Surgical intervention is being considered 1
• Neurologic symptoms are present (burning, tingling)—these require immediate subspecialist evaluation with EMG, nerve conduction studies, and MRI 1

Common Pitfalls to Avoid

• Do not inject corticosteroids near the Achilles tendon—this significantly increases rupture risk 2
• Do not overlook stress fractures in patients reporting increased walking activity before symptom onset, even with negative initial radiographs 1
• Do not use mobilization therapy without concurrent exercise therapy for ROM deficits 4
• Do not maintain complete immobilization beyond 3-5 days as this delays functional recovery 4, 2
• Do not assume bilateral heel pain is mechanical—evaluate for underlying rheumatic disease or systemic inflammatory conditions 1, 2