Members do not see these Ads. Sign Up.

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:

 

Re: Un responsive Heel Spur Syndrome/ Plantar Fasciitis

How sure are you its plantar fasciitis?

 

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

 

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

 

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

 

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.

 

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