Principles of Musculoskeletal Diagnosis

This report examines the principles of musculoskeletal diagnosis, focusing on inferior heel pain. It explores the causes, assessments, differential diagnosis, and management plan for this condition, providing a comprehensive overview for students.

Principles of
musculoskeletal Diagnosis

Table of Contents
INTRODUCTION..............................................................................................................3
MAIN BODY..................................................................................................................... 3
Aetiology...................................................................................................................... 3
Assessments................................................................................................................5
Differential diagnosis....................................................................................................7
Proposed management plan........................................................................................8
CONCLUSION............................................................................................................... 10
REFERENCES...............................................................................................................11

INTRODUCTION
Musculoskeletal diagnosis consist effective methods and techniques in order to
examine relevant disorders. It involves the injuries & disorders that affect movement of
human body or musculoskeletal system including muscles, tendons, ligaments, nerves,
discs, blood vessels etc. However, it consist some of common disorders such as Carpal
Tunnel Syndrome, tendonitis, ligament sprain, epicondylitis and many more (Fisher and
et. al., 2016). The present report is based on case study about inferior heel pain which
is a common complain affecting both genders with no ethnic predilection. This
assignment will focus on diagnosis and aetiology of inferior heel pain in order to assess
the problem to make appropriate decision to provide accurate medication or treatment.
It will also includes prognosis and treatment modalities for conducting appropriate
management the given problem of inferior heel pain.

MAIN BODY
Aetiology
The heel pain is generally feel under their heel or just behind it and this pain is
typically begins gradually with no injury to the affected area. It can be often triggered by
wearing a flat shoe and on most of cases the pain is under the foot and towards the
front of heel. However, it has been analysed that home care including ice, rest, feet
supports and proper fitting footwear are usually much effective ease the heel pain. In
addition to this, heel pain is not always caused due to same injury but from repetitive
stress and pounding the the heel in which some of causes are explained below.
Plantar fasciitis or inflammation of plantar fascia – The plantar fascia can be
considered as strong bowstring like ligament which runs from calcaneum to the tip of
the root. It involves the pain occurs due to the way of foot is made. However, the plantar
fascia get stretched too far then the soft tissue of the same get inflamed (Ferguson and
Turner, 2018). It remain generally connected to the heel but some times it may affect
the middle of the foot. Meanwhile, it is observed that pain felt under the area of foot after
long durations of rest and then Calf muscle cramps take place of the Achilles tendons
tightens too much.
Heel bursitis – This consist the condition in which inflammation can take place
at the back of the heel, in the bursa which is known as a fibrous sac full of fluid. It will
results into hard landing on heels or from a pressure from the footwear. However, it has
been observed that ache may be felt inside the deep or back of heel and Achilles
tendon may swell. Moreover, as the day progresses, the ache generally become worse
day by day.
Heel bumps – The problem of heel bumps can be considered as common issue
in teenagers and heel bone is not fully matured yet and it rubs excessively which results
into synthesis of too much bones. However, it can be caused because of flat foot and
begin wearing high heels before the time of bone become completely mature
(MacDonald, Stuart and Rodenberg, 2017).
Tarsal Tunnel Syndrome – This involves that a large nerve in the back of foot
becomes entrapped or pinched then it is a kind of compression neuropathy that may
take place in ankle of foot.

Chronic inflammation of the heel pad – This problem take place either the heel
pad become too thin or by the heavy footsteps.
Stress fracture – The problem of stress fracture occurs due to repetitive stress,
strenuous exercise, sports or heavy manual work. It has been analysed that runners are
specifically prone to stress fracture in metatarsal bones of the foot which can also be
caused because of osteoporosis.
Severs disease – This can be considered as a general reason behind problem
of heel pain in teenage athletes & child caused by overuse and repetitive micro trauma
of the growth plate of heel bone. Moreover, the problems usually impacts on children
between age group of 7 to 15 years.
Achilles tendinosis – This can also be known as degenerative tendinopathy,
tendinosis, tendinitis as well as tendinopathy which is considered as a chronic situation
linked with progressive degeneration of Achilles Tendon. Sometimes, it has been
observed that Achilles tendon does not function appropriately due to multiple, minor
microscopic tear of the tendon that cannot be heal & repair themselves in correct
manner (Browne and Barnett, 2016).
Some other causes – There are number of causes Achilles tendon rupture
where the tendon is torn, a plantar fascia tear, Baxter's nerve entrapment, calcaneal
stress fracture, calcaneal stress and soft tissue mass. It includes short flexor tendon
tear, systematic arthritis, bone bruise, problem with circulation, poor posture when
walking & running, bone cyst i.e. a solitary fluid filled cyst in bone. However, it involves
gout when uric acid levels rise in blood until urate crystals begin to build up in
surroundings of joints which is responsible for causing inflammation & severe pain.
Moreover, neuroma, osteomyelitis and rheumatoid which also cause heel pain.
Assessments
The assessment of inferior heel pain is very important which is required to be
done in accurate manner that facilitates to make accurate decision of providing
medication. It includes that proper diagnosing methods should be conducted to find out
actual cause of heel pain in order to provide correct treatment to make an individuals
disease free. However, it is necessary to make an appropriate care plan including more
effective medical facilities in respect to person well-being. Moreover, some of

diagnosing procedures and methods are explained further which can be used to assess
the problem of inferior heel pain (Beales and et. al., 2016).
Standard foot or ankle radiographs (X-rays) – This involves the method of X-
ray or radiography taking pictures of inside area of foot or ankle in order to determine
actual problem of heel pain. It includes that a machine focuses on small amount of
radiation on the area of body to be examined in which X-rays passed through the body,
creating an image on film or computer display to identify internal problem for treating the
same. However, physicians prefer to conduct primarily X-ray in respect of assessing the
actual problem like fracture in bone or muscle issue which helps to analyse cause of
inferior heel pain for providing medications for well-being of an individual.
Magnetic resonance imaging (MRI) – The MRI is a non invasive imaging that
develops three dimensional detailed anatomical images which is a kind of method used
for detection of specific health issue, diagnosis and monitoring of treatment. It includes
the MRI scanners which are particularly well suitable to image of soft tissues and other
parts like brain, spinal chord, nerves, muscles, ligaments and tendons can be observed
more clearly (Vijendren and et. al., 2016). However, it will provide support to physician
to assess the reason behind inferior heel pain which facilitate to make more effective as
well as efficient management care plan to make patient disease free.
Computed tomography (CT) Scan – The CT Scan can be described as a
diagnosing method which combines a series of X- ray images from different angles
around the body of patient. However, it utilise computerised processing in order to
develop cross sectional images of bones, soft tissues to determine internal problems
like inferior heel pain. In addition to this, medical practitioner are generally use this
method in terms of diagnosing muscle & bone disorders including bone tumours,
fracture and other related issue. Moreover, the physician apply this technique to
determine cause of behind inferior heel pain which helps to provide appropriate
treatment to patients for their wellness.
Three phase bone scan – This can be described as an effective method which
is usually prefer by medical practitioners in order to determine a fracture when it cannot
be seen on an X-ray. It involves to assess number of issue such as osteomyelitis, bone
pain, bone infection and other bone related diseases. However, a bone scan is a

nuclear imaging test that supports top track kinds of bone disease including unexplained
skeletal pain, bone injury or infection. In addition to this, the process of this method
consist an injection and a scan in which a series of images taken at different times
included (Messina, Orlandi and Sconfienza, 2016). Moreover, it can be used by
physicians to analyse the problem of inferior heel pain in patients to treat the same
properly.
Diagnostic ultrasound – The ultrasound imaging method involve the utilisation
of sound waves to develop pictures of inside part of the human body to determine
internal problem clearly. It includes images that provide valuable information in respect
of diagnosing and treating a variety of health problems and conditions. Meanwhile, it
has been analysed that ultrasound is utilised to support the criteria of diagnose the
reason of pain, swelling and infection in the internal organs of human body. In addition
to this, diagnostic ultrasound is also provide help to examine the condition of baby in
pregnant women and brain & hips in infants. Moreover, it can be used to assess the
problem of inferior heel pain to determine its actual cause for providing appropriate
medication.
Nerve conduction velocity testing (NCV) – This can be explained as an
electrical test which can be used for identifying the adequacy of conduction of nerve
impulse as it course down a nerve. It involves the criteria of mainly observe regarding
damage in nerves because the nerve is directly stimulated with an electrical current
during this test in order to observe reaction of the same. Meanwhile, NCV tests are
done in conjunction with electromyograms which can be used by care practitioners to
examine different types of neurological as well as muscular diseases. Moreover,
medical practitioners can used this method for utilising to detect accurate information
related to inferior heel pain in patients or treating the same in proper way (Amiri and
Khadivar, 2017).
Electromyelogram testing (EMG) – The method of electromyography (EMG)
can be described as an diagnostic method which can be used to measure responses of
muscles or electrical activity in response to nerve's stimulation of the muscle. At the
time of conducting this test, the one or more small needles (called as electrodes) are
inserted through skin into the muscle. However, the electrical activity picked up by the

help of electrodes can be displayed on an oscilloscope which is known as a monitor that
plays an important role of displaying electrical activity in the form of waves. Additionally,
care practitioners can utilise the method of EMG in respect of analysing inferior heel
pain of patients (Sconfienza and et. al., 2018).
Neurosensory testing – The neurosensory testing can be considered as a state
of the art accurate, painless and non invasive tool which can be used by physicians to
calculate the degree of neuropathy from its earliest onset. Basically, neuropathy is a
lack of normal sensation that affects an extremity which is mostly common in cases of
diabetes. Meanwhile, the method of neurosensory is efficient in measuring the pressure
threshold felt in the skin. Moreover, it has been analysed that physicians can used
nerosensory process of diagnose for examining the issue of inferior heel pain.
Additionally, it is helpful to make an appropriate decision making regarding care
services suitable for an individual's well-being.
Differential diagnosis
The differential diagnosis involve specified methods which can be used for
diagnosing specific health problem in order to provide appropriate medication for
wellness of patients. It involves number of procedures or tests which can be used
examine the actual causes of inferior heel pain which provide support to prepare more
effective as well as efficient care plan to make a person healthy (Sebastian, 2019).
Some of methods which are suitable to examine musculoskeletal problem of inferior
heel pain are explained below.
Disease or injury Differential clinical features
Neurologic Causes (entrapment
syndromes)
Radiating burning pain, numbness &
tingling, especially at night.
Tarsal, tunnel syndrome Diffuse symptoms over plantar surface.
Medial calcaneal branch of the posterior
tibial nerve entrapment
Medial and plantar heel symptoms
Abductor digiti quinti nerve entrapment Burning pain in heel pad area.
Skeletal causes Bony point tenderness

Calcaneal stress fracture activity Bony with weight bearing, worsens with
prolonged weight bearing.
Paget's disease Bowed tibias, kyphosis and headaches
Tumor Deep bone pain constitutional symptoms
late in the course.
Calcaneal apophysitis (Sever's disease) Posterior heel pain in adolescents
Soft tissue causes
Fat pad syndrome Atrophy of heel pad
Heel bruise History of an acute impact injury
Bursitis Usually retrocalcaneal, swelling and
erythema of posterior heel
Plantar fascia rupture Sudden acute, knife like pain and
acchymosis
Tendonitis Pain with resisted motions
Plantar fasciitis Self limiting condition
Proposed management plan
The management plan for inferior heel pain is required to be established in more
effective as well as efficient manner. It is necessary to follow the overall nursing care
plan step-by step in correct sequence in order to make patients well-being. However, it
consist few of medications and physical exercise along with number of precautions
which are helpful to make an individuals disease free. In addition to this, specific
medications and other related treatment procedures are required to be carried out for
providing appropriate care services for wellness of an individual. Basically, it has been
analysed that care practitioners should establish an effective care plan including more
suitable medications and other procedures in respect of gaining improved patients
outcomes respectively (Geschwind and Soulen, 2016). Moreover, it is essential to

provide efficient medications which facilitate to make an individual disease free and give
a comfortable life to them.
Medications and treatment for managing pain according to levels of tiers –
Tier I – Non steroidal anti-inflammatory drugs and cortisone injections are
recommended to patients having problem of heel pain with Tier I level.
Tier II – This condition requires repeated cortisone injections and botulinum
toxins for treating the same problem to manage the pain.
Tier III – This level of tier patient needs endoscopic plantar fasciotomy, in step
fasciotomy, minimal invasive surgical technique.
Non medical management of inferior heel pain –
Tier I – This kind of situation needs padding of the foot and therapeutic orthodic
insoles for short term pain relief. It also involves Achilles & plantar fascia stretching and
prefabricated & custom orthotic device as the prefabricated shows better results
compared to the custom device in the improvement of symptoms (Blankenbaker and
Davis, 2016). However, night splints, physiotherapy and cast or boot immobilisation
which facilitate to make patient feel relieved from severe inferior heel pain.
Tier III – The tier III level of problem requires to carrying out the suitable method
of extra corporal shock wave therapy which is helpful for reducing pain developed in
inferior heel. Moreover, the bipolar radio frequency is also efficient in order to provide
relief to patients from the problem of inferior heel pain respectively.
Physical therapy management
Low Dose Radio therapy – This method has an evidence that re-irritation of the
painful heel spur is a safe and effective treatment as there was a beneficial response in
terms of reducing the ache. It is essential to provide appropriate dose of therapy in
order to gain favourable outcomes for patient having inferior heel pain.
Cry ultrasound therapy and cryotherapy – These both therapies can be
considered as much effective in order to treat the problem of chronic plantar fascitiis
along with heel spurs. Basically the method of cry ultrasound therapy is known to be
more efficient as it gives better results to people (Al-Qahtani, 2016).
Thermotherapy – This treatment techniques consist two procedures such as
cold and hot therapy to be applied in suitable condition for wellness of an individual.

Initially, cold therapy can be utilised to relieve inflammation and reduce the pain
accordingly. Moreover, heat therapy can be preferred to used in respect to loosen tense
muscles and promote oxygen and blood flow to the affected area. Additionally,
thermotherapy might be useful in context of decreasing ache at the time of exercises.
Low level laser therapy – The method of low level laser therapy is examined as
an effective treatment technique in order to conduct treatment of heel spurs in an
appropriate manner. However, it is much efficient process for reducing pain of patient in
heels by conducting overall process carefully.
Conventional therapy – The conventional therapy involves number of
treatments including laser treatment, ultrasound, passive and active stretching of the
muscles in legs, cold & hot applicants. This process consist main aim to eliminate the
inflammation surrounding the spur and it consumes around 6 to 12 months for
resolutions of symptoms accordingly.
Conservation treatment – The conservative treatments are helpful in reducing
the symptoms of bone spurs but at the same time they are not applicable to treat source
of the pain always
CONCLUSION
From the above report, it has been concluded that musculoskeletal diagnosis can
be described as effective methods in order to examine relevant disorders. It involves
aetiology of inferior heel pain including plantar fasciitis or inflammation of plantar fascia,
heel bursitis, heel bumps, tarsal tunnel syndrome, chronic inflammation of the heel pad,
stress fracture, severs disease and Achilles tendinosis. Moreover, it includes specific
diagnosing methods to examine causes of inferior heel pain like Standard foot or ankle
radiographs (X-rays), Magnetic resonance imaging, Computed tomography Scan, Three
phase bone scan, Diagnostic ultrasound, Nerve conduction velocity testing,
Electromyelogram testing and Neurosensory testing. Additionally, some of treatment
procedures are described involving Low Dose Radio therapy, Cry ultrasound therapy &
cryotherapy, Thermotherapy, Low level laser therapy, Conventional therapy and
Conservation treatment.

REFERENCES
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