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Darren Costello Podiatry, 2 Lanyon Pl, Belfast (2026)

25/02/2026

Patient Case Study: Mechanical Overload… or Something Sinister?

Below is a patient I’ve seen in clinic recently where the use of POCUS was invaluable. It can be difficult to give nuanced detail about a case with the limited space on instagram, so feel free to get in contact.Patient consent ✅

Patient: 61F retail worker
Hx: 3 months of progressive posterior heel pain, swelling, stiffness worse in the AM and after rest.
Meds: Co-codamol, Amitriptyline, Amlodipine.
🚩 Maternal FHx of RHa

Using the Malliaras et al. framework, differentials for insertional pain included partial tear, retrocalcaneal bursitis, Haglund’s deformity, calcaneal stress reaction, plantar heel pain & TTS.

POCUS:
Normal Achilles 17mm) is a major red flag
• B-Mode + Doppler + History = robust clinical decisions 👣

12/12/2025

🎓🎓🎓
Officially graduated with my MSc in Sports & Exercise Medicine.
A fantastic course that has taught me so much. I’d encourage anyone looking to take their MSK skills to the next level to consider it.

17/11/2025

Guess the Diagnosis! 👇

Case:
7-year-old boy seen in clinic with right midfoot pain that started earlier this summer. Pain is localised to the navicular, with episodes of swelling, severe pain, and periods where he cannot weight-bear.

🖥️ PoCUS Findings:
➡️ Hypoechogenic navicular
➡️ Irregular cortical outline
➡️ Mild soft-tissue oedema
➡️ No fracture / no fluid collection

History:
📌 First episode during summer — woke unable to weight-bear, settled quickly in a boot
📌 Current flare triggered by increased football activity
📌 Altered gait during painful episodes
📌 No history of trauma

What’s your diagnosis? 👀
Drop your answer in the comments below! ⬇️

⸻

Answer:
Köhler’s Disease Köhler’s disease is a temporary avascular necrosis of the tarsal navicular, typically seen in active children aged 4–7. The blood supply to the developing navicular temporarily reduces, causing the bone to become painful, compressed, and inflamed.

We assessed him first in clinic and referred him for an X-ray. The report came back showing changes consistent with Kohler’s Disease, which was later confirmed by paediatric orthopaedics. He returned today in a walker boot.

Management:
✔️ Continue the boot short-term for symptom control
✔️Orthotics arranged for longer-term offloading
✔️ Education on the self-limiting nature of the condition
✔️ Sports as tolerated; rest + NSAIDs during flares
✔️ Awaiting routine paediatric orthopaedic review

06/11/2025

Change of scenery today — from to Newry for the live well road show.
We’re covering all things podiatry for the team — MSK assessments, ultrasound scanning, general foot care, and advice on keeping their feet healthy on the job 👣

07/10/2025

Guess The Diagnosis!!
28-year-old male footballer
3 months of pain at the back of his heel.
Pain is aggravated by sprinting, cutting, and tight boots.
Swelling noted just above the heel bone.
He describes pain when pressing on the back of the heel, particularly in shoes with a rigid heel counter.
On assessment, there is tenderness on deep palpation between the Achilles tendon and the calcaneus. Dorsiflexion of the ankle increases his pain.

❓ What do you think is going on?

✅ Answer down below:
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-
-
-
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Retrocalcaneal Bursitis
The retrocalcaneal bursa lies between the Achilles tendon and calcaneus. Repetitive loading, poorly fitting footwear, and sports involving sprinting/jumping can irritate the bursa, leading to posterior heel pain. It’s often confused with insertional Achilles tendinopathy but tenderness is more anterior and deep to the tendon.
Treatment may include activity modification, heel lifts, load management, and addressing footwear.
Due to the extent of this particular bursa and pain it was causing injection therapy was utilised. Slide 1 shows the injection, slide 2 and 3 show the bursitis before injection therapy. And slide 4 shows the bursa 100% pain free 7 days post injection.

08/08/2025

Excited to share that I’ve officially enrolled in the PGCert in Musculoskeletal Lower Limb Ultrasonography at 🎓📸 to gain my case accreditation and advancing my clinical skills

Also nearing the finish line with my MSc in Sports Medicine — just one more push to submit my research project!

31/07/2025

Recently, I treated a patient who ruptured their Achilles tendon while playing pickleball, a sport that’s increasing in popularity, particularly among older adults.

A 2024 study by McCahon et al. (McCahon et al., 2024) highlights a rising trend in Achilles injuries linked to pickleball, especially in older individuals. The sport involves rapid starts, stops, and lateral movements, which place intense stress on the Achilles — often in tendons already degenerating due to age and reduced elasticity.

In this case, we caught the injury quickly. Classic signs included:
• A sudden “pop” or the feeling of being shot or kicked in the back of the leg
• Difficulty with plantarflexion or pushing off the injured side
• A palpable gap in the tendon
• A positive Thompson test (no plantarflexion with calf squeeze)
• Point-of-care ultrasound (POCUS) clearly confirmed the rupture

We’ve referred the patient for urgent surgical repair, which offers a better outcome in active individuals when diagnosed early.

Takeaway: For those enjoying sports like pickleball later in life — don’t skip the warm-up, strengthen the calf complex, and never ignore tightness or sharp pain in the Achilles. Early recognition can be the difference between rehab and long-term disability.

Slide 1: Positive Thompson test
Slide 2: Visible gap where the injury has occurred on the Achilles
Slide 3: POCUS comparing symptomatic Achilles against asymptomatic

McCahon JAS et al. (2024). Pickleball and the Rising Incidence of Achilles Tendon Injuries in the Elderly, Foot Ankle Spec.

01/07/2025

Here’s a look at an Achilles tendon that’s been through it all — thickened, overloaded, and showing intense power doppler activity 🔥. That high neovascular signal often correlates with severe pain and dysfunction, even without the presence of calcification.

The patient openly admits they’ve never properly committed to a structured rehab plan — and they know just how important that piece of the puzzle is. Despite trying multiple passive interventions over time, the tendon hasn’t had the consistent progressive load it needs to adapt and recover.
We’re planning a high volume injection in the coming weeks to target the neovascularization and hopefully create a window of opportunity to finally rehab this tendon the right way — with progressive, load-based treatment at the centre.
Chronic tendons don’t heal with passive treatments alone — rehab has to be consistent, patient, and progressive. There are no shortcuts with tendinopathies.

16/04/2025

💉 Plantar Fasciitis – Over Injected or Under Injected? 🤔

As podiatrists, we’re often taught to be cautious with corticosteroid injections for plantar fasciitis — and that’s for good reason. Rupture risk is real, particularly when the fascia is already degenerated or partially torn (which is more common than many realise). But does caution sometimes tip into avoidance?

I find myself going back and forth. Are we underusing a valuable treatment option out of fear? Or are some healthcare professionals too quick to inject without thorough assessment resulting in unnecessary ruptures?

When done thoughtfully — with a detailed history, clinical exam, and ideally imaging — injection can be an effective part of a broader management plan. It’s all about context and clinical reasoning. 📋🦶

📸 Slide 1: Injection placed quite far back due to the patient’s point of maximal tenderness being at the very insertion. I am moving the needle around to make sure it’s in the correct place.  📸 Slide 2: Ultrasound-guided local anaesthetic injected along the fascia itself.

Curious to hear your views — is plantar fasciitis over injected, under injected, or just misunderstood? 👇

02/04/2025

Getting hands-on with the Force Decks, and I’m absolutely loving them! Super user-friendly, easy to read, and the auto-detect feature makes testing seamless.

From balance, asymmetries, and force production to tracking rehab progress, having objective data is a game-changer! Seeing those numbers improve over time is crucial for making informed decisions.
Also introducing the Dynamo Mini—an incredible tool for tracking ROM, strength, and asymmetries with precision. Combining both tools will be invaluable to our rehab process! 💪🔥

You might spot some of my dodgy jumping in the slides—just me getting familiar with the tests! Familiarization and cueing the patient are key for test reliability, especially in a clinical setting. Improvements aren’t always just rehab—it’s also about becoming more familiar with the movements.

Swipe to the final slide to see how all this data helps builds a full picture of an athlete and can help develop a specialized rehab program! 📊

07/03/2025

🔎 Case Study: When “Plantar Fasciitis” Isn’t the problem
Meet Conor—an active footballer, hurler, and runner whose training was derailed by persistent heel pain.

📍 The Onset
✅ Pain developed 18 months ago in the medial calcaneal region. ✅ No trauma—gradual onset. ✅ Initially diagnosed as plantar fasciitis.

🔬 Standard Treatments Failed
✔️ Custom orthotics ✔️ Shockwave therapy ✔️ Rehab program ❌ Relief was short-term—pain returned stronger with activity.

📍 Step 1: Ultrasound Findings
❌ No plantar fascia damage—fasciitis unlikely. ⚠️ Inflammation in the Flexor Hallucis Longus (FHL) tendon. ⚠️ Possible tibial nerve irritation (tarsal tunnel involvement uncertain).

📍 Step 2: MRI & Rehab Shift
🔹 Focused on FHL tendon rehab—some relief, but pain persisted. 🔹 MRI: No structural damage, mild ankle oedema (unclear significance).

💉 Step 3: Steroid Injection at Knot of Henry (Point of most localised tenderness)
✔️ Temporary pain relief (7/10 → 4/10). ❌ Pain returned with activity. ❌ New neurological symptoms (burning, tingling).

💡 Step 4: Rethinking the Diagnosis
➡️ Suspected tarsal tunnel syndrome from tibial nerve compression. ➡️ Guided hydrodissection injection (20ml solution) to free the nerve. (💉21ml solution Injected in total: Marcain (0.25%) – 10ml, Saline - 10ml, Depomedrone (1ml))

🚀 The Outcome
✅ Pre-injection pain: 7/10 ✅ 1 week post-injection: 1/10—pain-free after exercise & heavy labor. ✅ Long-term relief achieved!

🚨 Have you been told you have plantar fasciitis, or believed you were treating plantar fasciitis and it turned out not to be? Drop a comment below or DM me—I’d love to hear your story! 👇

Darren Costello Podiatry

25/02/2026

12/12/2025

17/11/2025

06/11/2025

07/10/2025

08/08/2025

31/07/2025

01/07/2025

16/04/2025

02/04/2025

07/03/2025

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