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Posterior Heel Spur

Jan 12th, 2014

Ricky asked The Guru for the following Physiotherapy Advice:

Dear Guru,

I am a Cricketer.< I represent the National Cricket Team of Nigeria as a Wicketkeeper/Batsman.

I am 34 years old. I have been very active.

I have been having Posterior Heel Spur since the past 1year. I have been taking Cortisone Injections for the past 6months. Have taken it 3times this year.

For the past 3months I have been avoiding any injections. Wondering how would I be able to find a full time solution to this problem.

Could you pls advice the way forward to a complete cure to this problem.

Ricky Sharma

Jan 12th, 2014

The Guru Responded:

Hi Ricky

I take it you mean a haglund deformity – a bump on the back of your heel where the achillles inserts, rather than a spur on heel (calcaneus) which gives pain under the foot, such as plantar fasciitis.

Normally there is a cascade of treatment options available [including physio in sport treatment], and I’m not sure  if these have or haven’t been tried (and failed) and so escalated.

This is an insertional Achilles tendon issue. Initial physical options runs through PRICE principles, heel raise, soft tissue release, eccentric loading program, dry needling, ESWT….then sticking needles in and around the tendon.

If this is where you are, and you shouldn’t have any more steroid injection – 3 is the maximum and it’s still failing, despite all the above, then a surgical approach needs to be considered.

Being a wicket keeper, this option should only be discussed with a surgeon who is a specialist in foot and ankle surgery. Your achilles needs to stripped from the bone, the bone reemed back to remove the bump and the tendon reattached. Keeping wicket obviously puts huge amount of continual load on the tendon, under stretch and so absolutely needs the right expert intervention.

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