The Diagnosis and Management of Heel Pain in Active People
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1 The Diagnosis and Management of Heel Pain in Active People Perry Julien, D.P.M. Past President, American Academy of Podiatric Sports Medicine Podiatry Coordinator, 1996 Summer Olympic Games Atlanta Georgia Private Practice, Atlanta Foot and Ankle Center
2 Heel Pain : The most common foot and ankle complaint in active people
3 The Heel and Related Structures Calcaneus Attachment of Plantar Fascia Location of Plantar Calcaneal Bursa
4 CAUSES OF HEEL PAIN Plantar Fasciitis Heel Spur Syndrome Plantar Calcaneal Bursa Stress Fracture Bone Tumors Arthritis sero-negative arthropathies fibromyalgia
5 CAUSES OF HEEL PAIN Plantar Fasciitis Heel Spur Syndrome Plantar Calcaneal Bursa Stress Fracture Bone Tumors Arthritis sero-negative arthropathies fibromyalgia
6 CAUSES OF HEEL PAIN Plantar Fasciitis/ Heel Spur Syndrome Plantar Calcaneal Bursa Stress Fracture Bone Tumors Arthritis sero-negative arthropathies fibromyalgia
7 CAUSES OF HEEL PAIN Plantar Fasciitis/ Heel Spur Syndrome Plantar Calcaneal Bursa Stress Fracture Bone Tumors Arthritis sero-negative arthropathies fibromyalgia
8 CAUSES OF HEEL PAIN Plantar Fasciitis/ Heel Spur Syndrome Plantar Calcaneal Bursa Stress Fracture Bone Tumors Arthritis sero-negative arthropathies fibromyalgia
9 CLINICAL EXAMINATION History Post-Static Dyskinesia Night pain (pain at rest) Location of pain plantar medial tubercle plantar heel (bursa) heel squeeze
10 CLINICAL EXAMINATION History Post-Static Dyskinesia Night pain (pain at rest) Location of pain plantar medial tubercle plantar heel (bursa) heel squeeze
11 CLINICAL EXAMINATION History Post-Static Dyskinesia Night pain (pain at rest) Location of pain plantar medial tubercle plantar heel (bursa) heel squeeze
12 CLINICAL EXAMINATION History Post-Static Dyskinesia Night pain (pain at rest) Location of pain plantar medial tubercle plantar heel (bursa) heel squeeze
13 DIAGNOSTIC TESTS Radiographs Tc99 Bone Scan Blood Chemistries MRI???
14 DIAGNOSTIC TESTS Radiographs Tc99 Bone Scan Blood Chemistries MRI???
15 DIAGNOSTIC TESTS Radiographs Tc99 Bone Scan Blood Chemistries MRI???
16 DIAGNOSTIC TESTS Radiographs Tc99 Bone Scan Blood Chemistries MRI???
17 TREATMENT OPTIONS Requires accurate diagnosis
18 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
19 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
20 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
21 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
22 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
23 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
24 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Corticosteroids/NSAIDs Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciotomy (EPF) Heel Spur Resection
25 TREATMENT OPTIONS Treat underlying problems first biomechanics footwear medical management when appropriate Stretching Arch Support Custom Molded Foot Orthoses Extracorporeal Shockwave Therapy (ESWT) Endoscopic Plantar Fasciectomy (EPF) Heel Spur Resection
26
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