Treating Heel Pain
New guidelines help doctors diagnose and treat heel pain
Heel pain is one of the most common and persistent foot problems affecting men and women of all ages, but new clinical guidelines, recently announced by the American College of Foot and Ankle Surgeons (ACFAS), will help physicians more readily diagnose and treat the disorder, according to Dr. Val Mullinax, an ACFAS member.
Appearing in a recent issue of the Journal of Foot & Ankle Surgery, the ACFAS guidelines were developed by a committee of prominent heel pain specialists. They are the outcome of an extensive evaluation of current treatment methods and success rates and a thorough review of the medical literature.
"The new guidelines are designed to help physicians diagnose and manage all types of heel pain and distinguish cases that should be treated conservatively from those requiring more specialized care,” said Dr. Mullinax. “Further, the guidelines will assure consumers that medical evidence presented to their physicians strongly favors non-surgical treatments for the large majority of heel pain cases."
It is estimated that 15 percent of all adult foot complaints involve plantar fasciitis, heel pain caused by chronic inflammation of the connective tissue extending from the heel bone to the toes. The condition can lead to heel spurs and occurs most frequently in adults 40 years and older, especially women. Being overweight and wearing inappropriate footwear are also contributing factors. In most cases, this form of heel pain can be treated with anti-inflammatory medications, stretching exercises and orthotics. Unresponsive cases, however, may require surgical intervention. Other types of heel pain are caused by nerve and circulation problems, arthritis, and stress fractures and other trauma.
According to the new guidelines, initial treatment options for plantar fasciitis include anti-inflammatory medications, padding and strapping of the foot and injections of corticosterioids. Patients also should stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use over-the-counter arch supports and heel cushions, and limit the frequency of extended physical activities.
"Most patients with plantar fasciitis respond to conservative treatment within six weeks," said Dr. Mullinax. "If improvement occurs, the guidelines specify that initial therapy should be continued until the heel pain is resolved. But if no improvement is evident, more specialized treatments, such as custom orthotics, or surgery, would be appropriate."