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Journal ArticleDOI

The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010

TL;DR: This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
Abstract: Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
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Journal Article
TL;DR: Conservative treatments help with the disabling pain and patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantarfasciotomy.
Abstract: Plantar fasciitis, a self-limiting condition, is a common cause of heel pain in adults. It affects more than 1 million persons per year, and two-thirds of patients with plantar fasciitis will seek care from their family physician. Plantar fasciitis affects sedentary and athletic populations. Obesity, excessive foot pronation, excessive running, and prolonged standing are risk factors for developing plantar fasciitis. Diagnosis is primarily based on history and physical examination. Patients may present with heel pain with their first steps in the morning or after prolonged sitting, and sharp pain with palpation of the medial plantar calcaneal region. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. Use of ultrasonography and magnetic resonance imaging is reserved for recalcitrant cases or to rule out other heel pathology; findings of increased plantar fascia thickness and abnormal tissue signal the diagnosis of plantar fasciitis. Conservative treatments help with the disabling pain. Initially, patient-directed treatments consisting of rest, activity modification, ice massage, oral analgesics, and stretching techniques can be tried for several weeks. If heel pain persists, then physician-prescribed treatments such as physical therapy modalities, foot orthotics, night splinting, and corticosteroid injections should be considered. Ninety percent of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting six months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.

239 citations

Journal ArticleDOI
TL;DR: Extracorporeal shockwave therapy (ESWT) seems effective in patients with non-calcified insertional Achilles tendinopathy and full range of motion eccentric exercises shows a low patient satisfaction compared to floor level exercises and other conservative treatment modalities.
Abstract: Purpose Systematically search and analyse the results of surgical and non-surgical treatments for insertional Achilles tendinopathy.

123 citations

Journal ArticleDOI
TL;DR: No clear consensus exists as to the relative strength of the risk factors reported, but how these factors interact may provide useful data to establish an individuals' risk profile for plantar fasciopathy and their potential for response to treatment.

116 citations

Journal Article
TL;DR: Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.
Abstract: Heel pain is a common presenting symptom in ambulatory clinics. There are many causes, but a mechanical etiology is most common. Location of pain can be a guide to the proper diagnosis. The most common diagnosis is plantar fasciitis, a condition that leads to medial plantar heel pain, especially with the first weight-bearing steps in the morning and after long periods of rest. Other causes of plantar heel pain include calcaneal stress fracture (progressively worsening pain following an increase in activity level or change to a harder walking surface), nerve entrapment (pain accompanied by burning, tingling, or numbness), heel pad syndrome (deep, bruise-like pain in the middle of the heel), neuromas, and plantar warts. Achilles tendinopathy is a common condition that causes posterior heel pain. Other tendinopathies demonstrate pain localized to the insertion site of the affected tendon. Posterior heel pain can also be attributed to a Haglund deformity, a prominence of the calcaneus that may cause bursa inflammation between the calcaneus and Achilles tendon, or to Sever disease, a calcaneal apophysitis in children. Medial midfoot heel pain, particularly with continued weight bearing, may be due to tarsal tunnel syndrome, which is caused by compression of the posterior tibial nerve as it courses through the flexor retinaculum, medial calcaneus, posterior talus, and medial malleolus. Sinus tarsi syndrome occurs in the space between the calcaneus, talus, and talocalcaneonavicular and subtalar joints. The syndrome manifests as lateral midfoot heel pain. Differentiating among causes of heel pain can be accomplished through a patient history and physical examination, with appropriate imaging studies, if indicated.

113 citations

Journal ArticleDOI
TL;DR: This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines to assist physicians in diagnosing and treating heel pain with plantar FASciitis.
Abstract: One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis.

111 citations

References
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Book
01 Dec 1987
TL;DR: This book discusses Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases and their applications in Musculoskeletal Diseases.
Abstract: Volume I: Radiography and Related Diagnostic Techniques in the Evaluation of Bone, Joint and Soft Tissue Diseases. Imaging of the Postoperative Patient . Volume II: Basic Sciences of Musculoskeletal Diseases. Rheumatoid Arthritis and Related Diseases. Connective Tissue Diseases . Volume III: Degenerative Diseases. Crystal-Induced and Related Diseases. Temporomandibular Manifestations of Articular Diseases. Target Area Approach to Articular Diseases. Volume IV: Metabolic Disease. Endocrine Diseases. Diseases of the Hematopoietic System. Infectious Diseases. Volume V: Traumatic, Iatrogenic and Neurogenic Diseases. Osteonecrosis and Osteochondrosis. Volume VI: Tumours and Tumor-Like Diseases. Congenital Diseases. Miscellaneous Diseases

2,274 citations

Journal ArticleDOI
TL;DR: The proposed classification criteria for spondylarthropathy are easy to apply in clinical practice and performed well in all 7 participating centers and are regarded as preliminary until they have been further evaluated in other settings.
Abstract: Classification criteria for most of the disorders belonging to the spondylarthropathy group already exist. However, the spectrum of spondylarthropathy is wider than the sum of these disorders suggests. Seronegative oligoarthritis, dactylitis or polyarthritis of the lower extremities, heel pain due to enthesitis, and other undifferentiated cases of spondylarthropathy have been ignored in epidemiologic studies because of the inadequacy of existing criteria. In order to define classification criteria that also encompass patients with undifferentiated spondylarthropathy, we studied 403 patients with all forms of spondylarthropathy and 674 control patients with other rheumatic diseases. The diagnoses were based on the local clinical expert's opinion. The 403 patients included 168 with ankylosing spondylitis, 68 with psoriatic arthritis, 41 with reactive arthritis, 17 with inflammatory bowel disease and arthritis, and 109 with unclassified spondylarthropathy. Based on statistical analysis and clinical reasoning, we propose the following classification criteria for spondylarthropathy: inflammatory spinal pain or synovitis (asymmetric or predominantly in the lower limbs), together with at least 1 of the following: positive family history, psoriasis, inflammatory bowel disease, urethritis, or acute diarrhea, alternating buttock pain, enthesopathy, or sacroiliitis as determined from radiography of the pelvic region. These criteria resulted in a sensitivity of 87% and a specificity of 87%. The proposed classification criteria are easy to apply in clinical practice and performed well in all 7 participating centers. However, we regard them as preliminary until they have been further evaluated in other settings.

2,164 citations

Journal ArticleDOI
TL;DR: This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations.
Abstract: J Bone Joint Surg [Br] 2010;92-B:651-5. Received 30 September 2009; Accepted after revision 26 January 2010 We present the long-term outcome, at a median of 18 years (12.8 to 23.5) of open posterior bone block stabilisation for recurrent posterior instability of the shoulder in a heterogenous group of 11 patients previously reported on in 2001 at a median follow-up of six years. We found that five (45%) would not have chosen the operation again, and that four (36%) had further posterior dislocation. Clinical outcome was significantly worse after 18 years than after six years of follow-up (median Rowe score of 60 versus 90 (p = 0.027)). The median Western Ontario Shoulder Index was 60% (37% to 100%) at 18 years’ follow-up, which is a moderate score. At the time of surgery four (36%) had glenohumeral radiological osteoarthritis, which was present in all after 18 years. This study showed poor long-term results of the posterior bone block procedure for posterior instability and a high rate of glenohumeral osteoarthritis although three patients with post-traumatic instability were pleased with the result of their operations.

1,329 citations

Journal ArticleDOI
TL;DR: Electrophysiological evidence of associated neural lesions in the neck of patients with carpal-tunnel syndromes or lesions of the ulnar nerve at the elbow is thought to be fortuitous, but rather the result of serial constraints of axoplasmic flow in nerve fibres.

882 citations