What hurts?
Some possible conditions • Heel Pain – Outside of Heel
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Piezogenic Papules -
Sprain/Strain
Some possible conditions • Heel Pain – Outside of Heel
Piezogenic pedal papules are a benign condition consisting of normal fat tissue that has extruded through the skin in the area of the heel. The papules usually appear on the inner side of the heel; they may also occur near the wrist. They are visible only when standing (weight bearing) and immediately disappear when non–weight-bearing. Occasionally, the papules will be painful but that is rare.
Piezogenic papules are most commonly diagnosed in otherwise healthy patients. Usually, they are not suggestive of systemic diseases.
Piezogenic papules present with firm, yellowish to skin-coloured papules that protrude from the inside (most common), outside or back aspects of the heel. The papules become more prominent when you stand in a full weight-bearing position and, by definition, go away when you remove weight. They are typically present on both the right and left side. The pain associated with them, which is rare, is felt differently; sometimes as a stinging, burning, or achy sensation.
In the rare case when these papules are painful, the pain has been attributed to the herniated fatty tissue having compression to its blood supply. The papules themselves are said to be more common in women, and appear spontaneously. There may a genetic component but this has not been proven. Finally, they can occur at any age and it is said that those who stand for long periods, and those who are obese are more at risk.
If no pain is present, treatment is typically not necessary. However, if pain or discomfort is present, it is recommended to wear compression stockings, orthotics and properly fitted footwear. Also, to avoid standing for long periods of time and consider weight loss if directed by your physician/nurse practitioner.
Ankle sprains and strains can create a pain on the inside of the heel bone. Sprains and strains have similar symptoms, causes and risk factors, but they also have some differences. Ankle sprains are usually a result of a traumatic or acute injury, while ankle strains can be acute or chronic. Acute injuries of the ankle occur suddenly and are caused by a single episode, whereas a chronic injury tends to develop after a period of time with repetitive movement or overuse. The ankle joint is formed by the tibia in the lower leg and the talus bone in the foot (which sits on top of the heel bone). There are dozens of ligaments to support the ankle and several muscles and tendons to provide strength and stability. If any of the ligaments are overstretched or disrupted, an ankle sprain may result. When the muscles or tendons are affected, a strain can occur. Note, that all of the muscles that come from the leg into the foot, cross the ankle and therefore, the heel/rearfoot.
The main difference between a sprain and strain is the onset of the pain, swelling, redness and reduced range of motion at the ankle. When an ankle sprain occurs, there may be an audible pop or a popping feeling, followed by bruising at the site and intense pain at the time of the injury. A strain will typically occur over time and can also result in weakness and instability around the ankle joint. A strain can also occur from a one-time injury or possibly at the same time as a sprain. Sprains and strains are graded from 1 to 3 and based on severity. Severity ranges from minor tearing to complete tearing of the soft tissues. Symptoms will be worse the higher the grade.
Ankle sprains and strains have similar risk factors including overtraining causing ligament or muscle fatigue, poor athletic conditioning, being overweight, not warming up sufficiently before training, poor and unsupportive footwear and history of a previous ankle injury. Another ankle injury is much more likely to occur after it has already been injured due to a sprain or strain. Additionally, women over the age of 30 and young men between the ages of 15 and 24 tend to be more at risk for ankle sprains. Activities and sports carried out on uneven terrain or involving pivoting on the spot or side-to-side movement may also increase a person’s risk for injury at the ankle. Inversion or eversion sprains can cause pain inside the heel, although eversion sprains tend to cause more pain in that region.
Healing after an ankle sprain can be lengthy as ligaments have little to no blood supply and knowing if ankle pain is a result of a sprain or strain is imperative for proper treatment and avoiding re-injury. Mild ankle sprains and strains can be treated at home with R.I.C.E, the age old application of rest, ice, compression and elevation. Ankle joint instability is common after injury. Ankle braces and taping can be effective for increasing stability, as are custom foot orthotics and appropriate footwear. Stretching and strengthening exercises will help to support and stabilise the weakened ankle joint. More severe injuries may also require immobilisation of the joint with traditional plaster casts or an air cast/boot. Surgery to repair the injured structures is only required if the first-line of treatment and rehabilitation is ineffective.
