Rearfoot disorders and conservative treatment: a narrative review

Abstract

Rearfoot disorders are frequently encountered in clinical practice. We reviewed common rearfoot disorders and present conservative treatments, focusing on shoe modification and the application of insoles or orthoses. Achilles tendinopathy is caused by excessive mechanical loads on the gastrocnemius and soleus muscles. Heel lifts, rocker shoes, and the AirHeel Brace can be used to reduce symptoms. Haglund's deformity is an osseous prominence of the posterosuperior part of the calcaneus bone, the pain from which can be alleviated by reducing pressure on the affected area by appropriately modifying the back of the shoe to prevent contact with the lesion. The pain from retrocalcaneal bursitis can be controlled by lifting the heel and loosening the shoe counter. Plantar fasciitis causes plantar heel pain, and its orthotic treatments include the application of a heel cup, heel pad, heel wedge, Thomas heel, and night splint. Calcaneal stress fractures are generally caused by repetitive loads and occur mainly in sporting activities. Patellar tendon-bearing (PTB) orthoses are helpful in reducing the load on the calcaneal bone. Heel fat pad atrophy refers to the loss of the fat pad that absorbs shock in the heel. To reduce pain caused by heel fat pad atrophy, rocker soles, heel pads, and solid ankle cushion heels (SACHs) may be used. Tarsal tunnel syndrome is caused by compression of the tibial nerve within the tarsal tunnel and its symptoms can be managed by rocker soles, supporting medial arches, Thomas heels, and SACHs. Shoe modification or application of orthoses can be helpful for managing rearfoot pain. However, for the active and wide application of these conservative treatment methods, more clinical studies should be conducted.

Keywords: Conservative treatment; insole; orthosis; rearfoot disorder; shoes.