Calcar calcanei

Calcar calcanei is a pain syndrome or inflammation in the heel region of the foot which commonly affects individuals who are overweight, spend extended periods of time sitting, standing still or walking and it is also common with long distance runners. Pain in the base of the heel, ie. calcar calcanei, is seen as an overuse syndrome because it primarily occurs due to accumulation of microdamages caused by longlasting overload of the foot and heel region. Plantar fascia acts as a ligament spreading along the lenght of the sole and one of its connecting spots is the exact spot on the base of the heel where the pain occurs.

Pain can be acute or chronic, in the acute phase the pain is intense and sudden and with chronic pain its intensity is lower, the pain is dull, it occurs gradually and can have a longlasting effect, ie. it does not subside during the day. It is often a result of nontreatment or inadequate treatment. This syndrom most often affects individuals that have long episodes of walking or standing still, it can come in combination with various foot deformation (flat foot, varus or valgus foot position, stiff Achilles tendon, etc) and it is a common occurence with long distance runners.

Calcification or loss of blood flow and softness in the place where the plantar fascia connects to the base of the heel can develop and it creates pain and a local inflammation process during tracktion which occurs at that spot in different activities.

Rehabilitation encompasses pain and inflammation relief methods in the acute phase, use of ice, rest and different physical therapy methods such as ultrasound, electrotherapy, shockwave therapy, massage, etc. In the functional phase of the therapy lower leg and sole muscles as well as the Achu+illes tendon should be stretched throught different stretching approaches and if there is any deficit in lower leg or foot muscles strenght it should be adressed and that muscle gropu should be properly strenghtened (most often in the peroneal muscle group, lateral part of the lower leg). It is improtant that all factors causing this syndrome and pain be removed; body weight mass should be lowered if it is too high, shortened muscles should be stretched, feet deformations should be resloved throough use of orthopaedic foot pads, better uality footwear should be used, training should be changed and adapted if it was a factor in developing this syndrome. In most cases a conservative therapy approach is usedand  surgical approach is only advised if the symptoms and pain last through a longer period (6 and more months).

Prevention: regular physical activity, qulaity footwear, use of orthopaedic pads if needed, lower leg and sole muscles as well as Achilles tendon stretching, resolving any possible muscle strenght deficits in the lowere leg and foot muscle groups, maintaining a balanced body weight, avoiding a sedentary way of life and long periods of standing and also impelemnting a corrective exercise program for individuals whose profession implies long periods of either standing or sitting.