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January 27, 2003 Common Diagnoses: Sub-calcaneal Bursitis

Sub-calcaneal Bursitis is an inflammation of the large bursa that acts as a cushion under the inferior aspect of the calcaneus. Cause: Sub-calcaneal bursitis is caused by the excessive eversion of the calcaneus at heel strike and during stance phase. There are two tuberosities at the proximal plantar base of the calcaneus of which the medial tuberosity is more prominent and distinctly edged. With the excessive eversion, this medial edge delivers more force per unit area and shearing to the bursa which can cause inflammation. In Sharper Edge the overly supinated foot, the cause is most likely the Bursa concentrated Calcaneus Inverted plantar pressure on the heel. Symptom: This typically hurts more centrally in the plantar heel pad and worsens during the course of the day. Plantarfasciitis, in contrast, is tender at the medial distal corner of the fat pad and the pain is most acute with the first step in the morning. Diagnosis: Palpation of the center of the plantar fat pad under the heel elicits sharp pain. Treatment: Anti-inflammatories and physical modalities (Ultrasound, thermal contrast applications) may give temporary relief and promote blood-flow/healing. However, without addressing the abnormal biomechanical stresses the condition will probably progress or reoccur. Stretching the gastroc/soleus muscles, when tight, will eliminate that component which could be a source of over-pronation. When stretching this muscle be sure to internally rotate the leg and supinate the foot for maximum stretch efficiency. Sole Supports will address the problem in two important ways. The full contact design allows the weight to be more evenly distributed across the plantar surface of the foot, especially helpful in the overly supinated foot. Edge Directly Over Bursa Most importantly, by controlling overpronation, normal calcaneal Calcaneus Everted position during stance phase is restored, both tuberosities at the calcaneal base can bear weight more evenly and distribute the force over a larger area. Prognosis: With Sole Supports, the prognosis is excellent. You should expect 50-70% relief the first month, 70-90% the second month and 90100% the third. Special Orthotic Design: A modification called a "U" pad can be added to the heel of 1/8" poron to accomodate this bursa.



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