Keys To Addressing Heel Pain In The Athlete

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A Checklist For Heel Pain Treatment

Biomechanical: taping/padding, prefab insoles, custom functional orthotics

Treating inflammation: NSAIDs, cortisone injections, ice

Surgical treatment depending on cause: exostectomy, release or decompression, repair, etc.

Inflammatory conditions: coordinate and work with the primary care provider

Return to activity guidelines: cross-training, physical therapy

Shoe recommendations/activity specific

Stretching guidelines for heel pain

Tim Dutra, DPM

   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.

Suggested Reading
1. Jolly GP, Zgonis T, Hendrix CL. Neurogenic heel pain. Clin Podiatr Med Surg; 2005; 22(1):101-113.
2. Lui E. Systemic causes of heel pain. Clin Podiatr Med Surg; 2010; 27(3):431-441.
3. Dellon AL. Deciding when heel pain is of neural origin. J Foot Ankle Surg. 2001; 40(5):341-345.
4. Elengard T, Karlsson J, Silbernagel KG. Aspects of treatment for posterior heel pain in young athletes. J Sports Med. 2010; 1:223-232.
5. Tu P, Bytomski J. Diagnosis of heel pain. Am Fam Phys. 2011; 84(8):909-916.
6. Toomey EP. Plantar heel pain. Foot Ankle Clin N Am. 2009; 14(2):229-245.
7. Williams SK, Brage M. Heel pain-plantar fasciitis and Achilles enthesopathy. Clin Sports Med. 2004; 23(1):123-144.
8. Aldridge TA. Diagnosing heel pain in adults. Am Fam Phys. 2004; 70(2):332-338.
9. Chiodo WA, Cook KD. Pediatric heel pain. Clin Podiatr Med Surg. 2010; 27(3):355-367.
10. Vyce SD, Addis-Thomas E, Mathews EE, Perez SL. Painful prominences of the heel. Clin Podiatr Med Surg. 2010; 27(3):443-462.
11. Burns PR, Scanlan RL, Zygonis TZ, Lowerry C. Pathological conditions of the heel: tumors and arthritidies. Clin Podiatr Med Surg. 2005; 22(2):115-136.
12. Aronow MS. Posterior heel pain. Clin Podiatr Med Surg. 2005; 22(1):19-43.
13. Hunt KJ, Anderson RB. Heel pain in the athlete. Sports Health. 2009; 1(5):427-434.
14. Solan M, Davies M. Management of insertional tendinopathy of the Achilles tendon. Foot Ankle Clin N Am. 2007; 12(4):597-615.
15. Forman WM. Heel pain. Clin Podiatr Med Surg. 1990; 7(2):203-397.

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