Posterior Heel/Calcaneal pain
first post today, I really enjoy the forum.
I have just seen a 20 year old man playing sport at a very high level. He presented with posterior heel pain, posterior lateral aspect of calc. No history of injury, present for 2 months. only sore when training in football boots, not when runing in trainers or at any other time. No pain on palpation of heel or palpation of Achilles tendon or along the tendon. No Inflammation, bursa or any sign of any problems.
Bony prominence here slightly protruding but nothing abnormal and similar to other foot.
Initially thought boots, but pt said wearing boots for year prior to problem and has changed twice sine to no avail, 2 week rest period reduced pain initially but it returned after a few training sessions. Has a Cavus foot type, but not very severe and some mobility there although very little eversion. Pt doing all the stretching and exercises going for lower limb and foot.
Have checked his stretching and provided off-loading padding of the posterior calc prominence to start. Also 'low-dye' taping with 15mm valgus padding to try. I personally think it is probably the boots and even the new ones are just too tight (Gaelic footballers like to wear them tight to "feel" the ball') and that protecting the posterior heel we might sort the problem out and perhaps a simple poron protector in the boots may help.
I was just wondering if anyone had come across something like this before. He plays sport at a very high level and I really would like to try and sort him out or refer him to who can. Any suggestions would be greatly appreciated. Had a look at the severs disease section but I feel he is too old. Also wondering whether anyone thinks bimechanical treatment would be a direction to go in here, no plantar callus present.
Thanks in advance for any suggestions,