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Heel Spur vs. Plantar Fasciitis: Patient Education

Discussion in 'General Issues and Discussion Forum' started by Donna, Aug 22, 2007.

  1. Donna

    Donna Well-Known Member


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    Hi All,

    I currently have a patient who presented with heel pain, and, to spare you all of the boring details, I diagnosed plantar fasciitis and went about the usual process of explaining to the patient the cause, short term treatment and long term treatment options.

    This patient was accompanied by Xrays that were previously ordered by the GP showing a large plantar spur, and the GP wants to inject with cortisone. The patient is reluctant to have this treatment and therefore sought Podiatry advice hoping for a "milder" alternative (orthoses anyone?). :D

    The patient so far has responded well to short term treatment of ice/tape/supportive shoes, and I have discussed long term treatment with orthoses and how they can help reduce tensile stress on the plantar fascia etc etc, however, she still seems convinced that the spur is the cause of her pain and that cushioning the spur (perhaps with a donut pad as she suggested :rolleyes: ) will solve her heel pain. I have tried to explain that the spur has formed as a result of the ligament tensile force over time, but I feel that I am going around in circles explaining the "hows" and "whys" of the pathomechanics and treatment, and no matter how much I simplify my explanation, she still doesn't seem to understand... :(

    My questions is, how do other pods explain to the patient the difference between plantar fasciitis and heels spurs? :confused: How much do you simplify your explanation? I normally use fairly basic terms and show the patient the skeleton model and diagrams on anatomy posters so the patient can try and visualise their condition...

    What else is there?

    Regards

    Donna :)
     
  2. Craig Payne

    Craig Payne Moderator

  3. Donna

    Donna Well-Known Member

    Hi Craig,

    Maybe I should make her some functional orthoses with a nice juicy heel pad to "help the spur"... :p

    I'm going to try for the third time to explain it to her again when I see her on Friday... ;)

    Regards

    Donna
     
  4. Robertisaacs

    Robertisaacs Well-Known Member

    I usually try to explain it as the heel spur being a symptom of the pain, kinda like the spots in measles. Putting ointment on the spots won't affect the measles virus. I tell them that better than half the population, were they to be x rayed, have heel spurs which do not cause any pain at all. I tell them that the PF is the actual cause of the pain and that if we just cushion the spur it won't stop the fascia pulling.

    Try telling them to imagine that the PF is a piece of rope tied to an eylet hook which is screwed into their heel bone. Imagine that rope is pulling too hard and pulling the screw out of the bone. It will make the whole heel bone hurt but cushioning will not stop the screw being pulled out.

    Mind you, might be as easy to do a bog standard orthotic with a 3mm ressessed bit of poron in there if the education becomes hard work!

    Regards
    Robert
     
  5. Donna

    Donna Well-Known Member

    Hi Robert,

    Thanks for that, your explanation does sound quite good doesn't it? I'll give that a shot tomorrow and see if the patient understands the Robeer reasoning... :D

    Regards

    Donna
     
  6. Kevin Kirby

    Kevin Kirby Well-Known Member

    Donna:

    These are common questions in most podiatry practices. Here is how I may address the patient:

    "You have a condition called plantar fasciitis which may, or may not be, associated with a spur on the bottom of your heel bone. Many patients who have severe heel pain have no heel spur on their x-ray. Also, there are also many patients who have very large heel spurs on x-ray, but have never had any heel pain. Therefore, since there seems to be poor correlation between the presence or absence of a heel spur on x-ray and the amount of heel pain, we treat the patient the same whether or not they have a heel spur on x-ray."

    Here is something else I may add on plantar fasciitis for patients:

    "The condition of plantar fasciitis is caused generally by a pulling of the long ligament, the plantar fascia, on the bottom of the foot on the heel bone during standing, walking and running. However, since the point of attachment of the plantar fascia is on the bottom of the heel bone, then plantar fasciitis may also be caused by direct pressure from the impact forces from ground on your heel bone, just as you may have experienced by walking on a small pebble while barefoot and developing a "stone bruise". Your orthotics will be designed to both reduce the stretching of the plantar fascia and to reduce the pressure from the ground on the bottom of your heel which should give us the best chance of permanently eliminating the pain from your plantar fasciitis."

    Hope this helps.
     
  7. Donna

    Donna Well-Known Member

    Hi Kevin,

    Thanks a lot for your help... From what you and Robert have explained, I think I am definitely on the right track (despite some minor changes to the plantar fasciitis "story") with explaining the condition to the patient, and I think most people can understand that simplified explanation. :cool:

    I guess there's always going to be one or two patients that can't quite grasp the concept of anatomy and foot problems... Much like your "Thought Experiments" I guess, some get it a little faster than others... I recently did an inservice with the physios at the multi-disciplinary practice that I work at, and used some of your Thought Experiments to help the physios visualise how STJ axis can affect Pronation and Supination Moments. The 2 male physios loved the diagrams and understood the concepts almost immediately, whereas the female physio took a little longer to grasp the concept... ;)

    Regards

    Donna
     
  8. Cameron

    Cameron Well-Known Member

    Donna

    If they have x rays then I explain the spur may have nothing to do with the pain otherwise I describe and enthesopathy.

    Cameron
     
  9. Scorpio622

    Scorpio622 Well-Known Member

    If the patient has xrays, I will use a piece of paper or ruler aligned with the plantar calcaneus and first met head to show that the spur never contacts the ground. Most are surprised to see this because their perception (mentally and nocioceptively) is that the spur is pointing downward.

    Most patients accept this demonstration and we move on......
     
  10. Kevin Kirby

    Kevin Kirby Well-Known Member

    However, Donna, you have demonstrated quite good ability in solving the thought experiments so the ability to think in this fashion is probably not just dependent on being male or female. After over 20 years of teaching these concepts my conclusion is that, simply, some people have it and others don't. Or as Dr. John Weed used to tell me regarding his teaching of podiatric biomechanics, 1/3rd of his students thinks he is great and very smart, another 1/3rd of his students dislike him and don't understand the material at all, and the other 1/3rd don't know what to think.
     
  11. Donna

    Donna Well-Known Member

    Hi Cameron and Scorpio...

    Thanks for the tips... I will see how I go when I see the patient later today... She does have Xrays and will be bringing them in to show me. ;)

    And Kevin, thanks again for the kind words, the Thought Experiments are a great idea and very helpful in explaining the concepts of forces and their effects on injury. I'd love to be able to use the diagrams to explain to this patient today, but somehow I don't think she comes from a very scientific background and probably won't understand... :p

    Regards

    Donna :)
     
  12. Donna

    Donna Well-Known Member

    Hi All,

    OK so the patient came in today and after some more explaining - she seemed to understand - finally! :D Yay! So thanks to you all for your help!

    However, just to make this story even more fun... today she informs me that she is subject to a 2 month waiting period on her health insurance so custom devices will have to wait until then. :rolleyes: The countdown begins...

    Regards

    Donna :)
     
  13. Nat

    Nat Well-Known Member

    I would've just convinced her to let me give the steroid injection.
     
  14. Admin2

    Admin2 Administrator Staff Member

  15. NewsBot

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    The Practical Application of Multimedia Technology to Facilitate the Education and Treatment of Patients With Plantar Fasciitis: A Pilot Study
    Andrew Donald Beischer, Andrew Clarke, Richard Noel de Steiger, Leo Donnan, Aileen Ibuki, and Rebecca Unglik
    Foot & Ankle Specialist 2008 1: 30-38.
     
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