A Guide To Conservative Care For Plantar Heel Pain
Given that heel pain is one of the most common maladies that podiatrists treat, this author offers a pertinent overview of conservative therapies ranging from corticosteroid injections and night splints to low-Dye taping and platelet-rich plasma.
Current estimates suggest there may be over one million visits to physician offices per year for plantar fasciitis.1 Given that it may be the most common condition podiatrists see, the podiatric community should have a firm handle on the different etiologies of plantar fasciitis, differential diagnosis and treatment options as well as treatment algorithms or protocols they follow because variations exist in the management of plantar fasciitis. Indeed, one systematic review identified 26 methods of treating plantar heel pain.2
We see plantar fasciitis in adults on a regular basis and almost 11 percent of all foot complaints are attributed to plantar fasciitis.3 Heel pain can be very disabling for some patients and at times, patients can become frustrated with the lack of progress with treatment. If conservative treatment has failed, one should look for other possible etiologies that may be the source of pain prior to proceeding to surgery. Other conditions like tarsal tunnel syndrome, inflammatory arthropathies, nerve entrapments and calcaneal stress fractures are just a small sample of other etiologies of heel pain in adults.4 The literature is replete with both conservative and surgical treatment options for plantar fasciitis but the scope of this article will focus on conservative treatment for plantar fasciitis.
Anatomically, the plantar fascia is a thick aponeurosis that attaches to the inferior calcaneus and courses distally to attach to the base of the proximal phalanges of all five digits. The plantar fascia is comprised of three bands: medial, central and lateral. The primary functions of the plantar fascia are to plantarflex the metatarsals and support the medial longitudinal arch. Computer models have shown that disruption of this structure can lead to flattening of the medial longitudinal arch and increase pressure under the metatarsal heads.5,6 By definition, plantar fasciitis is inflammation of the plantar fascia and the thickness reportedly increases with age.7
Pertinent Diagnostic Insights
Other names for plantar fasciitis that clinicians use interchangeably include heel spurs, heel pain syndrome and heel spur syndrome.8 The prevailing thinking on plantar fasciitis is that it is an overuse injury. Researchers have identified abnormal biomechanics, obesity and improper footwear as possible etiologies.9-12 One recent study even found an association longitudinally between plantar fascia thickness and diabetic retinopathy and renal dysfunction.13
The history of a patient with plantar heel pain is critical in the diagnosis and treatment. Patients may complain of first step pain after a period of rest that generally eases after several minutes of ambulation and may worsen with continued activity. It is not unusual for patients to complain of continuous pain throughout the day that does not subside until they go to bed. Other information that one should obtain includes the type of footwear, the level of activity at work (standing/sitting), the surface the patient works on and any previous history of trauma.