If you are thinking of custom orthotics, make sure that patient responds to low-Dye strapping and that he or she will follow shoe recommendations. As the saying goes, “The orthotic is only as good as the shoe that you put it in.”
Exhaust all conservative care before considering surgery whenever possible. The sooner you can identify the cause of heel pain and start appropriate treatment, the better.
Return to activity guidelines should aim at “under promising and over delivering.” Usually, the longer the patient has had heel pain, the longer it will take to resolve. You will be a hero if the recovery is faster than anticipated.
If the patient is not progressing with the treatment plan and has been adherent, rethink the diagnosis as it may be one of the other many causes of heel pain. Order appropriate lab work and diagnostic studies, and use referrals. Often, the heel pain can be multifactorial in nature.
Remind the patient to wear supportive foot gear at all times and avoid flip-flops or sandals as much as possible as support and cushioning can be keys for the successful response of a treatment plan. Emphasize the importance of proper footwear and fit. Patients need to replace shoes on a regular basis.
Weight control and physical conditioning are critical to success for treating the mechanical causes of heel pain. If the patient is overweight, prescribe exercise (one may consult the primary care provider), recommend cross-training and give him or her guidelines to stay fit. Remember, exercise is medicine. Be a mentor and role model for your patients.
Dr. Dutra is an Assistant Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a podiatric consultant for Intercollegiate Athletics at the University of California, Berkeley. He has masters degrees in Kinesiology and Health Care Administration.
Dr. Dutra is a Fellow and Past President of the American Academy of Podiatric Sports Medicine. Dr. Dutra is also a Fellow of the American College of Sports Medicine, the American College of Foot and Ankle Orthopedics and Medicine, and the American Professional Wound Care Association. He is a Distinguished Practitioner of Podiatric Medicine with the National Academies of Practice.
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