Presentation
A hardworking hairdresser suffering from obesity. Heel pain and tenderness aggravated with activity. No history of trauma.
Patient Data
Bony protrusion at the posterosuperior aspect of calcaneus (at the insertion site of the Achilles tendon), suggesting enthesopathy.
The fat just anterior of the Achilles tendon, where the retrocalcaneal bursae is located, looks relatively normal.
There's also an enthesophyte at the origin of the plantar fascia suggestive of enthesopathy.
Case Discussion
Achilles enthesopathy and plantar fasciitis are two common causes of posterior heel pain.
Enthesopathy refers to a disorder involving the site of attachment or insertion of ligaments, tendons, fascia, or articular capsule into bone. This site of attachment is called enthesis, and its inflammation is known as enthesopathy. It may be caused by chronic traction of the Achilles tendon on the calcaneus. Contracted or shortened calf muscles (sedentary lifestyle/obesity) and athletic overuse are other possible causes. Spondylarthropathy can also cause enthesopathy.