Treatments of the Heel

The calcaneus, or heel bone, plays an important role in walking. A calcaneal osteotomy is a controlled break of the heel bone, performed by a foot and ankle orthopaedic surgeon, to correct deformity of the foot and ankle. 

The heel bone can be realigned to achieve a different orientation, which can correct many different deformities and functional limitations. For example, abnormally high or low arches are deformities that can be addressed with a calcaneal osteotomy. The ultimate goal of all osteotomies is to relieve pain, improve alignment and walking, and reduce the likelihood of arthritis. 

The calcaneus is the heel bone. Fractures or breaks of the calcaneus commonly occur after a fall from a height or car accident. Treatment of these fractures may require surgery.

The goal of heel fracture surgery is to restore the shape of the heel bone as close to normal as possible. Restoration of normal alignment and contour is considered the best way to restore function and minimize pain.  

A bunionette (also known as a tailor's bunion) is a painful bony prominence, or bump, on the outside of the fifth (little) toe. Over time, the bunionette may worsen as the fifth toe moves inward and the fifth metatarsal (the bone connected to it) moves outward. Rubbing between the bump and tight shoes may also cause a callus to grow over the fifth toe area. All bunionettes can cause pain and pressure on the outside of the foot, though often they do not cause symptoms.

An osteotomy is a surgically performed cut of the bone. A fifth metatarsal osteotomy refers to a cut in the head, neck, or shaft of the bone to make it straighter and the bony prominence smaller. This reduces rubbing on the outer side of the foot and decreases or eliminates the pain. 

Adult flatfoot is a condition that is characterized by the collapse of the arch of the foot. Surgery will improve alignment of the foot and restore more normal pressure during standing and walking. A combination of procedures often is needed to repair the ligaments and tendons that support the arch. Bone cuts are made to help restore the arch. Proper correction of flatfoot deformity can help reduce pain and improve walking ability.

A Haglund's deformity is a bump in the back of the heel bone. The Achilles tendon runs over the bump. Patients with a Haglund's deformity may or may not have pain. Sometimes, the pain is caused by shoes rubbing against the bump. At other times it can be part of pain of degeneration in the Achilles tendon due to the pressure placed there. It is not always clear how much of this Achilles tendon problem is due to the Haglund's deformity.

If prominence is the main issue, then the goal of Haglund's deformity surgery simply is to make the heel bone less prominent. If the Achilles tendon has degenerated as well, then the procedure may involve the Achilles tendon directly.

Each foot has five metatarsals. These are the long bones of the foot. They connect the toes to the rest of the foot. They also make the ball of the foot. The lesser metatarsals are the bones that connect to the second through fifth toes (not the first, or big toe). 

An osteotomy is a cut made in the bone. It is similar to breaking the bone but in a very controlled manner. A lesser metatarsal shortening osteotomy changes the pressure distribution under the ball of the foot, relieving pain. It also can be used to put a chronically dislocated toe back in position.

A peroneus longus (PL) to Achilles tendon transfer is done to restore strength across the ankle joint. Strength may have been lost due to an injury to the Achilles tendon or a neurological disorder. Also, patients with Achilles tendon pain that has not improved from non-surgical treatment may benefit from this transfer. Other tendons (such as the tendon to the big toe or lesser toes) may be chosen for the transfer instead of the PL, based on the underlying anatomy and function.

The plantar fascia (PF) is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing, and helps with shock absorption. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Ten percent of people have pain in the bottom of the heel at some point in their life. The most common cause is plantar fasciitis, which can result from overactivity, improper shoes, flat feet or excessive weight on the feet.

The plantar fascia is a thick band of tissue that connects your heel bone to your toes. It helps support the overall shape of your foot, especially when standing. Irritation and scarring of the plantar fascia, known as plantar fasciitis, is one of the most common causes of heel pain.

Often there is no one event that triggers heel pain. It generally develops over time and can become extremely painful, especially with the first few steps in the morning. It is more common in women, those who walk a lot and people who are overweight. Risk factors include your natural foot shape (flat or high arch), your activities (walking, running) and improper shoes.

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

Parts of the ankleWhen there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

The subtalar joint is located just below the ankle joint between the talus and the calcaneus (heel bone). The main job of the subtalar joint is to allow for side-to-side movement of the foot and ankle. This movement aids in walking, especially on uneven surfaces.

When there is a problem in the subtalar joint, the location of pain is described as being deep. The exact location may be hard to describe. Pain may be felt in the soft spot on the outside of the ankle or in a horseshoe distribution behind and below the ankle.

Fusion is locking the bones together. A triple arthrodesis is a fusion in the hindfoot (back of the foot) used to treat many types of painful foot deformities. This procedure fuses the joints under the ankle that allow the foot to move from side to side. These joints are the talonavicular, subtalar, and calcaneocuboid.

Surgeons try to avoid fusions, but sometimes pain and deformity are so severe that this procedure offers the best chance of producing a less painful foot with better alignment. Fusions often improve stability and allow for easier standing and walking. The hindfoot fusion is a time-tested, durable procedure.