Heel Pain: Heal! Amie C. Scantlin, DPM, MS, FACFAS Glencoe Regional Health Services (320) ext. 1933

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1 Heel Pain: Heal! Amie C. Scantlin, DPM, MS, FACFAS Glencoe Regional Health Services (320) ext

2 Important Notice The information contained in this document is for informational purposes only. It is not intended to diagnose or treat specific patients and should not be used as a substitute for the medical care and advice of your health care provider. In addition, this document may contain references to specific products and/or medications. Such references, whether by brand name or generically, are provided for informational purposes only and do constitute endorsement, recommendation, or approval by GRHS or its medical providers. Always consult a medical professional if you have concerns regarding your health. If you are experiencing a medical emergency, dial 911. **Due to copyright and the graphic nature of the images used in this presentation, many images have been removed from the original presentation. If you would like a copy of the original slides, please contact the events coordinator at

3 Heel Pain: Your Feet Don t Have to Feel 100 Years Old!!

4 Symptoms Severe pain in the heel or arch when getting out of bed in the morning (I feel like I m 100 years old!!) Pain improves with walking Pain can return after periods of rest Feels like a stone bruise

5 Plantar Fasciitis Inflammation and pain along the plantar fascia - the tissue band that supports the arch on the bottom of the foot Usually on the bottom of the heel at the point where the plantar fascia attaches to the heel bone

6 Plantar Fasciitis Becomes chronic in 5-10% of all patients Is not necessarily associated with a heel spur Over 95% resolve with conservative treatment

7 More Plantar Fasciitis Symptoms Radiating pain to the arch and/or toes May be caused from flat shoes or shoes with no support

8 Even More Plantar Fasciitis Symptoms In later stages, pain may persist/progress throughout the day Pain varies in character: dull aching, bruised feeling. Burning or tingling, numbness, or sharp pain may indicate local nerve irritation

9 Plantar Fasciitis Risk Factors Biomechanical abnormalities Overly tight calf muscle Poor shoe choices Weight gain Barefoot walking Work surface

10 Plantar Fasciitis: Evaluation Pain with pressure on bottom of heel or arch Limping Foot Type: low vs. high arch, pronation

11 Plantar Fasciitis: Diagnosis X-ray findings Spur? Other abnormalities? Ultrasound Nerve Conduction Velocity studies to evaluate potential nerve problems MRI rarely used. Mostly for chronic, unresponsive cases

12 Plantar Fasciitis Treatment Mechanical treat the cause Anti-inflammatory treat the pain Neither done in isolation Adjust exercise regimen

13 Exercise Modification Cease all high impact activities Walking on treadmill Walking on cement/ track Begin low impact exercises Swimming Stationary bike Elliptical machine Slowly return to intensity and mileage

14 Plantar Fasciitis Treatment Stretching, shoe modifications, avoid walking barefoot Icing and rest Night or resting splint Supplemental arch support (OTC vs. custom orthotics)

15 Orthotic Therapy Custom-molded arch support Takes tension off plantar fascial band Proven effective treatment for acute and chronic heel pain

16 Additional Treatment Options Anti-inflammatory medication Physical therapy, including stretching and massage If conservative measures fail, surgery is an option

17 Heel Spur Syndrome Pain associated with a spur on the bottom of the heel Close cousin of plantar fasciitis Pain often caused from size of the spur alone Treatment is exactly same as plantar fasciitis initially with addition of injection therapy

18 Other Potential Causes of Heel Pain Calcaneal apophysitis (children) Arthritis Stress fracture Achilles tendon problems Bone cyst Pinched nerve/nerve entrapment Low back or disk problems

19 Other options for heel pain Over 95% of heel pain patients respond to initial therapies within a relatively short period of time For unresponsive cases, options include: Work-up for spinal impingement including Lumbar spine MRI Surgical procedures, open or endoscopic Rule out other causes of heel pain including tarsal tunnel syndrome

20 Tarsal Tunnel Syndrome Similar to Carpal Tunnel Syndrome in the wrist Impingement of the posterior tibial nerve along its course into the foot Mimics heel spur syndrome/ plantar fasciitis Patients are unresponsive to heel pain treatments

21 Surgical Options Plantar Fascial Release vs. Removal of Heel Spur

22 Plantar Fascial Release Purpose is to release band from attachment to heel bone or calcaneus

23 Heel Spur Resection with Plantar Fascial Release Reduction of the spur Concomitant release of plantar fascial band

24 Video BKy4&feature=player_embedded

25 Conclusion Heel pain occurs frequently in men and women Resolves in 95% of cases Early treatment is important Be good to your feet!

26 Visit Dr. Scantlin! For more information on heel pain, or for a diagnosis, contact your podiatrist: Amie Scantlin, DPM, MS, FACFAS Glencoe Regional Health Services Glencoe Clinic (320) ext.1933 Thank you for coming today!

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