Heel pain from the American Podiatric Medical Association

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American Podiatric Medical Association (APMA) presents an interesting slideshow on heel pain and potential treatments for patients.

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Heel pain from the American Podiatric Medical Association

  1. 1. Heel Pain Doctor’s Name Doctor’s Office Location Doctor’s Phone Number Website/Email address
  2. 2. Plantar Fasciitis <ul><li>Inflammation and pain along the plantar fascia - the tissue band that supports the arch on the bottom of the foot </li></ul><ul><li>Usually on the bottom of the heel at the point where the plantar fascia attaches to the heel bone </li></ul><ul><li>Becomes chronic in 5-10% of all patients </li></ul><ul><li>Is not necessarily associated with a heel spur </li></ul><ul><li>Over 90% resolve with conservative treatment </li></ul>
  3. 3. Plantar Fasciitis Symptoms <ul><li>Pain on standing, especially after periods of inactivity or sleep </li></ul><ul><li>Pain subsides, returns with activity </li></ul><ul><li>Pain related to footwear – can be worse in flat shoes with no support </li></ul><ul><li>Radiating pain to the arch and/or toes </li></ul><ul><li>In later stages, pain may persist/progress throughout the day </li></ul><ul><li>Pain varies in character: dull aching, “bruised” feeling. Burning or tingling, numbness, or sharp pain, may indicate local nerve irritation </li></ul>
  4. 4. Plantar Fasciitis Risk Factors <ul><li>Biomechanical abnormalities </li></ul><ul><li>Overly tight calf muscle </li></ul><ul><li>Poor shoe choices </li></ul><ul><li>Weight gain </li></ul><ul><li>Barefoot walking </li></ul><ul><li>Work surface </li></ul>
  5. 5. Other Potential Causes of Heel Pain <ul><li>Calcaneal apophysitis (children) </li></ul><ul><li>Arthritis </li></ul><ul><li>Stress fracture </li></ul><ul><li>Achilles tendon problems </li></ul><ul><li>Bone cyst </li></ul><ul><li>Pinched nerve/Nerve entrapment </li></ul><ul><li>Low back or disk problems </li></ul>
  6. 6. Plantar Fasciitis Evaluation & Diagnosis <ul><li>Pain with pressure on bottom of heel or arch </li></ul><ul><li>Limping </li></ul><ul><li>Foot Type: low vs. high arch, pronation </li></ul><ul><li>X-ray findings – Spur? Other abnormalities? </li></ul><ul><li>Ultrasound </li></ul><ul><li>Nerve Conduction Velocity studies to evaluate potential nerve problems </li></ul><ul><li>MRI –rarely used. Mostly for chronic, unresponsive cases </li></ul>
  7. 7. Plantar Fasciitis Treatment <ul><li>Mechanical – </li></ul><ul><li>treat the cause </li></ul><ul><li>Anti-inflammatory – treat the pain </li></ul><ul><li>Neither done in isolation </li></ul>
  8. 8. Plantar Fasciitis Treatment <ul><li>Stretching, shoe modifications, avoid walking barefoot </li></ul><ul><li>Icing and rest </li></ul><ul><li>Night or resting splint </li></ul><ul><li>Supplemental arch support (OTC vs. custom orthotics) </li></ul><ul><li>Anti-inflammatory medication </li></ul><ul><li>Steroid injections </li></ul><ul><li>Physical therapy </li></ul><ul><li>If conservative measures fail, surgery is an option </li></ul>
  9. 9. Other options for heel pain <ul><li>Over 90% of heel pain patients respond to initial therapies within a relatively short period of time </li></ul><ul><li>For unresponsive cases, options include: </li></ul><ul><ul><li>Minimally invasive procedures like ESWT (Extracorporeal Shock Wave Therapy) </li></ul></ul><ul><ul><li>Autologous Platelet Concentrate (APC) injection </li></ul></ul><ul><ul><li>Surgical procedures, open or endoscopic </li></ul></ul><ul><ul><li>Cryosurgery </li></ul></ul><ul><ul><li>Radiofrequency techniques </li></ul></ul>
  10. 10. Visit Your Podiatrist <ul><li>For more information on heel pain, or for a diagnosis, contact your podiatrist: </li></ul><ul><li>Doctor’s name </li></ul><ul><li>Doctor’s location </li></ul><ul><li>Contact information </li></ul><ul><li>Thank you for coming today! </li></ul>

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