Heel Pain Is So Much More Than Plantar Fasciitis

July 27, 2017

Participating Organization Tracks, Session 3: Heel Pain: Diagnosis and Conservative Treatment
Friday, July 28
3:30–5:30 p.m.
Tennessee B

Studies show that 90 percent of the 2 million patients diagnosed each year with heel pain or plantar fasciitisrespond to conservative care. A Friday session will reinforce the concept of conservative care and explore options for patients who do not respond to it.

Three speakers at the session, presented by the American College of Foot & Ankle Orthopedics & Medicine (ACFAOM), will examine the biomechanical aspects of plantar fasciitis, how imaging can play a key role in diagnosis, and other causes of heel pain.

“There are patients who just do not get better, and it becomes frustrating for the patient as well as the podiatric physician,” said ACFAOM President Daniel P. Evans, DPM, session moderator.We will look at what is the most common cause for patients having this problem and then we will discuss other etiologies for heel pain.”

Presenting the session with Dr. Evans will be Stephen F. Albert, DPM, ACFAOM immediate-past president, and Jason C. Harrill, DPM, ACFAOM president-elect.

Dr. Albert will explain the causes of plantar fasciitis and the role of orthotics in pain relief in “Emphasizing Current Biomechanical Concepts.”

“The biggest theory for the development of plantar fasciitis is that patients are excessively pronating and putting a strain on the plantar fascia,” Dr. Evans said. Using that as a springboard, Dr. Albert will discuss how it can occur in different foot types and adjustments for orthotics to get a better clinical response.

In “Imaging Options for the Assessment of Complicated Heel Pain,” Dr. Evans will examine the role of radiology when diagnosing the cause of heel pain.

“We can utilize and assess our plain film radiography, as well as MRI and ultrasound, to better assess the details of where the pathology is located, and use the imaging modalities to obtain a diagnosis and direct our plan of care,” Dr. Evans said. “We will talk about indications and when in the treatment algorithm you should consider ordering those tests.”

When patients do not respond to conservative therapy for plantar fasciitis, the cause of heel pain may lie elsewhere, such as a tumor or a nerve entrapment. Dr. Harrill will evaluate other treatment options during “Beyond Orthotics: Viable Options for the Patient With Recalcitrant Heel Pain.” Conservative therapy emphasizes stretching exercise programs, the use of NSAIDs, and the use of good shoes.

Dr. Harrill will expand on options you might consider before surgery. He will describe the Graston Technique, which is a physical therapy technique of deep massage and stretching. Some other options are plasma-rich platelet injections, dry needling, human amniotic membrane injections, and coblation, which uses radiofrequency treatment to ablate some of the inflamed tissue.

The session will close with an interactive segment of case reviews, including the differential diagnosis for patients who do not respond to treatment.

“Our hope is that people will go back to their offices and look a little differently at that patient with plantar fasciitis who is not responding,” Dr. Evans said. “They may have some tools to better address why those patients have not been responding, and have the opportunity to think of other options they might use.”  

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