Plantar heel pain and its 3-mode 4-stage treatment

Abstract

The most common cause for heel pain is plantar fasciitis. The diagnosis can usually be made by clinical examination, but sometimes ENMG (electroneuromyography), ultrasound, and magnetic resonance imaging examinations are helpful. Other reasons for heel pain, e.g., nerve entrapments, atherosclerosis/ischemia, and fat pad degeneration, should be excluded. Plantar fasciitis can also present a symptom of chronic seronegative spondyloarthropathies or reactive arthritis. In the case of common plantar fasciitis, three different modes of treatment can be administered, namely, (1) anti-inflammatory and analgesic treatment, (2) rest and diminution of the strain at the insertion, and (3) maintenance of the tension and flexibility of the soft tissues. A simple four-step treatment plan algorithm, based on symptoms, their duration, and response to treatment, is presented. Operative treatment is seldom needed if the algorithm is correctly followed. Operative treatment is recommended only when the pain remains resistant to conservative treatment after more than 1 year. For operative treatment, partial release of the fascia close to insertion to avoid flat foot and secondary strain on the calcaneocuboid and midtarsal (Lisfranc) joints is our preferred option.

The Relationship between Plantar Fasciitis and Plantar Heel Pressure

“…Indeed, in the clinic, heel cushions and heel cups are popular initial treatment modalities for most types of heel pains. However, the effectiveness of this intervention is poorly understood (29)(30)(31)(32).…”

Impact of chronic plantar fasciitis on work-related activity

“…Pain in the area of the heel is one of the main reasons workers seek appointments with orthopedists in emergency rooms and outpatient clinics. Among the various diseases related to this symptom, such as Achilles tendinopathy, tarsal tunnel syndrome and plantar fascia ruptures, the most common is plantar fasciitis (1,2) . Plantar fasciitis is defined as an inflammatory and degenerative disorder located in the proximal region of the central band of the plantar fascia (1,3,4) .…”

“…Plantar fasciitis is defined as an inflammatory and degenerative disorder located in the proximal region of the central band of the plantar fascia (1,3,4) . Studies deduce that it affects approximately one million Americans every year, accounting for 1% of all orthopedic appointments in the United States (US), at an annual cost of 192 to 376 million dollars (2)(3)(4)(5)(6) .…”

Estudio prospectivo sobre la influencia de la densidad de energía en la eficacia del tratamiento de la fascitis plantar con ondas de choque focalizadas

“…Las radiografías simples (Rx), como se ha relatado con anterioridad, no son necesarias para el diagnóstico de la FP pero pueden resultar útiles para descartar otras causas de dolor plantar del talón si la condición no responde adecuadamente al tratamiento o en caso de sospecha de posible patología ósea (Michelsson et al, 2005). Puede mostrar lesiones óseas del pie como tumores óseos o fracturas.…”