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Unresponsive Heel Spur Syndrome/ Plantar Fasciitis

Discussion in 'General Issues and Discussion Forum' started by bendzeetoe, Dec 21, 2007.

  1. bendzeetoe

    bendzeetoe Welcome New Poster


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    I have a patient with medial calcaneal pain. x-ray displays a heel spur. Pt has a 6 yr history of P. Fasciitis but pain is now only at calcaneus.

    New orthoses were prescribed, along with NSAIDS and stretching. The pain improved slightly with NSAIDS but once they were stopped it returned to normal. Orthoses do not seem to be helping

    Any suggestions on where to go from here?

    Thanks and Merry Christmas:santa:
     
  2. Craig Payne

    Craig Payne Moderator

    Articles:
    8
    Re: Un responsive Heel Spur Syndrome/ Plantar Fasciitis

    How sure are you its plantar fasciitis?
     
  3. Admin2

    Admin2 Administrator Staff Member

  4. 1. Cortisone injections
    2. Plantar fasciitis night splints
    3. Cam walker boot and/or below knee immobilization cast
    4. Partial plantar fasciotomy
     
  5. Daniel Bagnall

    Daniel Bagnall Active Member

    Hi,

    Are you completely sure that the pt is being complient with shoes, stretching, orthotic usage, and any other conservative treatment/advice you have given?

    If the pt is overweight and is working in an occupation which requires them to be standing on hard surfaces all day, then treating this condition can be challenging.

    Did you comprehensively rule out possible neurologic causes i.e nerve entrapement, before you diagnosed plantar fasciitis? This can be commonly overlooked.

    Regards,

    Dan
     
  6. Shane Toohey

    Shane Toohey Active Member

    Dear Bendzeetoe,

    Perhaps a couple of questions first.
    Exactly where on the heel does this patient feel the pain? Medial, lateral , central, posterior?
    What was your prescription for the orthoses?

    Cheers
    Shane
     
  7. gangrene1

    gangrene1 Active Member

    Hi Bendzeetoe,

    you may want to try:
    1) low dye strapping
    2) pneumatic /cam walker

    The sports med doctors at the hospital provide ESWT (extra-corporeal shockwave treatment) for chronic heel pain cases.
     
  8. drsarbes

    drsarbes Well-Known Member

    Hi Ben....
    Well, after 6 years you can place him in the CHRONIC heel pain category!
    Once you rule out other etiologies, including Tarsal Tunnel/Porta Pedis syndromes, I would suggest fasciotomy with heel spur removal.
    I have found (particularly fluoroscopic aided procedures) to be very effective and quick healing. These patients are back in their own shoes in one week and usually back to normal activity in 3 to 5 weeks.
    Steve
     
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