Diagnosis for all heel pain "plantar fasciitis"?

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just wondering............

should the term for ALL types of heel pain be called "plantar fasciitis?" if so why go through different names sometimes specific to aetiology at university . Granted treatment methods are still the same but it sometimes feels like groundhog day when referals to the sector i work in know all about the cause/condition/and how to rx this often tounge twister of a term before coming in the door!! think for future ref maybe the term should be used less. lets think of a new generalised one, i know "heel pain!"
kinda feel deflated suppose its like saying (although another generalised term, this time for pma pain) ............you have metatarsalgia!!

chaz

 

What University did you go to? If it was LaTrobe, then you must have been asleep in the heel pain lectures...plantar fasciitis is a very specific diagnosis with many many many other conditions causing plantar heel pain and other similar symptoms. (...or am I misunderstanding what you are saying )

 

Are you sure you really want to say this on Podiatry Arena?

 

I missed that in the first post. Not sure what you got taught at University, but thats not the case at ours. Getting the ddx right is what should distiguish us from the rest of the pack (see this)

 

Dear Chaz,

I don't mean to pick on you , but how can you use the term/diagnosis "plantar fasciitis" less often when it is such a frequently occurring condition in a world where the risk factors for developing plantar fasciitis are so prevalent?

You can't tell me that all of your patients are either not overweight or wearing poor footwear - just 2 factors that I seem to see as more than a coincidence when assessing heel pain (specifically plantar fasciitis).

Regards

Donna

 

hi donna yep totally agree with what you have said. didnt mean to come accross the idiot i did (have just read my own post back!). of course i know p.fas is so frequent in occurance all i meant to say is sometimes the many other types of heel pain get forgotten. kinda what craig p said in the last part of the post.
hope this makes sense.

 

Hi Chaz...

So what you meant to say was more regarding the number of patients that are previously diagnosed with plantar fasciitis incorrectly, either by self diagnosis/internet or other practitioners overlooking other ddx's for heel pain?

Gotcha... (I hope)

Regards

Donna

 

That is more than a little frustrating! The google generation are sadly prone to misdiagnosing themselves this way and i suppose we cannot expect more from them, but i never cease to marvel at some of the refferals i get with PF particularly from GPs. Some Of them the pain is'nt even plantar! I mean honestly, the clue is in the name, if its pain in the achillies tendon or the dorsum of the foot its highly unlikely to be PLANTAR fascitis.

Some days i think the page on feet in the GMC's standard textbook reads

Pain in the heels = plantar fascitis
Pain in the Arch = Fallen arch
Pain anywhere else = Metatarsalgia.

I hate tounge twisters . When i was at uni it was often taught as "calcaneal enthesopathy." Try saying that 5 time quickly!

Oh and

 

I agree, and don't forget the myriad of patients with corns that come either self or pre-diagnosed with verrucae...

I know this is slightly off track, but I read in one of the newspapers (Courier Mail maybe, I can't remember) recently where they did one of those random street surveys asking people if they would be likely to use an online diagnosis service and one person did actually respond along the lines of "yes - because it saves me money not having to go to the doctor"... hmmm...

It does get frustrating "re-diagnosing" these "second hand" patients, but I guess satisfaction eventually occurs when you manage to assess, diagnose and treat the condition correctly and successfully...

Regards

Donna

 

I'm actually impressed if a patient or GP has come up with a diagnosis of PF instead of a heel spur!

 

Ha! Ha! Nice one, Yeah well said.

Dave

 

Some heel pain can be a stress fracture of the calcaneus.The key:squeeze the sides and if pain is elicited,you may have a stress fracture.
Had a lady today with tarsal tunnel syndrome with burning,cramping,pain.I gave a PT block and she felt better in seconds.I started her on lyrica for the pain.

 

PF FOR ALL.Well there is all always plantar heel pain syndrome,a 100 per cent correct diagnosis if rather imprecise.

 

I love diagnosis like that.

Juvenile idiopathic arthropathy:- Lit, They're young, they've got joint problems and we don't know why!!!

Idiopathic toe walker.:- Lit, They're toe walking, We don't know why.

Medical language is great! we get to sound so cool whilst admitting we don't know what is actually causing the problem!

Regards

Robert

 

Idiopathic toe walker? Shouldn't that be habitual toe walker? Still no firm reason as to why the child is displaying this kind of gait, but a bit more precise. It's just a habit that needs to be broken. Parents seem to take that on board more and become active in their childs treatment and not just demand orthotics which, they fail to grasp, are not going to help the problem.

This is my first entry folk's. Look forward to chatting again soon.
Regards
Penny

 

Hi penny. Hope you enjoy yourself.

Yes i agree ITW is a poor diagnosis. I don't use it any more than i talk about Metatarsalgia, i was just illustrating a point.

BTW where did you get the idea that orthotics are not going to help the problem?

Regards
Robert

 

Hi Robert
I wasn't being picky, just illustrating that it's still the same problem, still don't know why kids do it, but sounds a bit better. For the parents.

I'm interested to hear about any orthotoic devices that can prevent toe walking though.

Cheers Penny

 

AFO's obviously, and Rigid footplates work quite well. Think Gait plates but rather than the biplanar rocker a pure saggital rocker extending beyond the MPJS. Or just a bog standard Carbon fibre base plate in the shoe.

ANd you're right. Habitual sounds better and is more accurate.

Regards

Robert

 

Hi Robert
Depends what kind of patient are you thinking about though. Habitual toe walkers don't require that kind of therapy. That's why i was interested to see your suggestions. I think for patient's that have cerebral palsy, Duchennes and other kind of spastcic/paralytic disorders that would be fine. and the cost justified too.

Well, this certainly strayed from the plantar fascia title!
Thanks for the chat

 

A thread that strayed?!

You'll find that happens a lot. Theres one which started on Rothbarts insoles and is presently focusing on the fact that rabbits have to eat their own poo. Actually thinking about it thats not so different...

I would argue that that kind of orthotic IS justified in certain patients who are habitual toe walkers. I will intervene under the following circumstances:-

1
If the patient is not responding well to stretches for whatever reason.
2.
If the patient is developing skin lesions due to forefoot loading.
3
If the toe walking has persisted beyond, say 8 years old
4
If the toe walking is causing the child to trip lots
5.
If the toe walking is causing excessive concern to the patient or parents.

I accept that habitual toe walking almost invariably self resolves eventually, however i think that there is still a case to be made for treating it under certain circumstances. It stikes me that there are similarities between this and the intervention in cases of asymptomatic paediatric flat feet. We know that the majority of cases will just grow out of it, however many podiatrists (including me) will still treat with orthotics under certain conditions.

Regards
Robert

PS if you are going to become an active member of this forum you need to get yourself a decent avatar. Its the law.

 

In the limited cases of toe walking that I've seen, I could never find a musculoskeletal or neurologic cause.

Could this simply be related to low spectrum autism ?????

 

The latest Podiatry Today has the full text of this:
A Guide To The Differential Diagnosis Of Plantar Fasciitis

Full article

 

Medial calcaneal nerve entrapment as a cause for chronic heel pain.
Diers DJ.
Physiother Theory Pract. 2008 Jul-Aug;24(4):291-8

 

As a current student we get taught that PF is very specific to the area of the medial calc that can track a few cm's along the medial longitdual arch.

That DD for PF paper looks like a good read.

slightly off topic it is the term Metatarsalgia I dislike, becuase to me that that describes nothing but the location, this maybe my naivety/confussion as a student.

Nick

 

Accurate diagnosis is most reliant on identifying the affected tissue and taking a comprehensive patient history. This requires a deep understanding of surface anatomy/palpation and a very good level of knowledge of the possible diagnoses and how to differentiate them by the symptoms.

There is a good reason to use many different terms for heel pain. Each term differentiates the conditions by the tissue affected and the pathophysiology. You need to be specific in your diagnosis so you can be specific with your treatment plan. Treating a calcaneal stress fracture with orthotics rather than rest because you thought the condition was plantar fasciitis is not good treatment.

The other generalised injury term I hate is shin splints! :bang:

 

the term shin splints doesn't make sense though, i have woundered why it was ever called that.

Normally it is muslce over use like MTSS, compartment sydrome etc

If it a splint in the shin isn't that a fracture


I even here pyshio was the term shin splints, surly they can say words like MTSS and know that it is not 'shin splints' unless they have x - ray eyes

this bugs me so much and i am only a student

nick

 

Sometimes it is better to use the generic term rather than the jargon term. For example orthotics should be used with patients rather than orthoses because that is the word that everyone but podiatrists use. However calling an injury shin splints, even to patients, clouds the issue and reduces the communication about what their problem really is. In some situations it is just semantics and in others it is better communication.

 

Plantar pain is not always fasciitis.
Romano N, Fischetti A, Prono V, Migone S, Barbieri F, Pizzorni C, Garlaschi G, Cimmino MA.
Reumatismo. 2017 Dec 21;69(4):189-190. doi: 10.4081/reumatismo.2017.989.