Role of Calcium, Calcitriol and Intralesion Corticosteroid for Heel Pain Management in Women

Abstract

Plantar heel pain is a commonly encountered Orthopaedic problem in women that can cause significant discomfort and difficulty in bearing weight. Proximal plantar fasciitis is twice as common in women as in men (2). An infracalcaneal spur frequently is associated with the symptomatology of plantar fasciitiss. METHODS AND MATERIAL: It's a retrograded study of 72 female patients came in orthopaedics OPD with complain of planter heel pain. Age more than 30 years. Out of 72 patients, 59 were peri menopausal age group (> 40 years) and 13 were younger age group (30-40 years). 43 patients had radiological evidence of calcaneal spur. 29 patients have bilateral heel pain. We treated all these patients by life style modification, use of heel pads, stretching exercise of foot and ankle, analgesics (as and when required) calcium and calcitriol supplementation for 3 months. In 25 cases the diagnosis were made planter fasciitis and one foot is involved more with point tenderness persisted after 2 weeks of above mention treatment, we gave intra-lesion methyl prednisolone injection along with above mention treatment. DISCUSSION: We found 45.83% of patient s responded to this treatment within one month, 70.83% responded within 3 months and 65.27% showed improvement even after 6 months. CONCLUSION: Treatment of plantar heel pain should proceed in a stepwise fashion and, according to the patient's response, as follows. First, modify or suppress the alleged risk factors, give an NSAID, prescribe a stretching program for the Achilles tendon, and recommend orthotics such as heel pads .Calcium and calcitriol supplementation specially in peri menopausal women with bilateral heal pain. If these fail, give one or two local injections of a methylprednisolone.

Intrinsic Factors Affecting Early Results of Extracorporeal Shock Wave Therapy (ESWT) Treatment in Patients With Symptomatic Calcaneal Spur

“…Etiyolojisinde birden fazla neden rol oynamaktadır. Sporcularda görülme nedeni sıklıkla kötü zeminde aşırı kullanıma bağlı iken, sedanter bireylerde obezite ve iş nedeniyle uzun süre ayakta durmak gibi plantar fasyada biyomekanik stres yaratan durumlar ve kalkaneal tuberositteki entezittir (1).Topukta ağrıya ve bölgesel hassasiyete sebep olabilecek diğer durumlar ise; plantar fasya rüptürü, tarsal tünel sendromu, lateral plantar sinirin 1. dalına bası, kalkaneus stres kırığı, kemik kisti veya tümörü, osteomiyelit, spinal stenoz, intervertebral diskte prolapsus, romatolojik hastalıklara bağlı artritlerdir (1).…”

“…Plantar topuk ağrısının sık sebeplerinden olan plantar fasyopati, yetişkinlerin %3,6--7'sinde görülür (1). Koşu ile ilgili tüm yaralanmaların %8'i topuk ağrısına sebep olurken, genç sporcularda plantar fasyopati görülme sıklığı (%2,5) yaşlı sporculardan (%6,6) daha düşüktür (2).…”

“…Cinsiyet açısından değerlendirildiğinde, kadınlarda erkeklere oranla iki kat fazla plantar fasyopati görüldüğünü bildiren yayınların yanında erkeklerde daha sık olduğunu iddia eden çalışmalar da vardır (1,2). Vücut kitle indeksi (VKİ)'nin artışı çoğu hastalıkta olduğu gibi plantar fasyopatide de major risk faktörüdür ve spontan iyileşmeyi geciktirir (3).…”