74: Heel Pain - Smith

Question 1

define plantar fasciitis

Answer 1

Plantar stress, tendinitis and inflammation of the plantar fascia with or without a spur or inferior calcaneal exostosis

Question 2

how often is a spur assoc with heel pain?

Answer 2

11% of US population and 73% of patients with heel pain have a spur

“heel spur syndrome”

Question 3

etiology PHP

Answer 3

• Repetitive traction with inflammation
• Pronation
• Increased body weight or activity
• Systemic or Rheumatological disorders

Question 4

diagnositc s/s PHP

Answer 4

• Radiating, deep aching heel pain
• Poststatic Dyskinesia [pain in morning, gets better throughout day OR pain after sitting, gets better w/ movement]
• Pain of palpation, Hubscher Maneuver [dorsiflex hallux to recreate windlass mech]
• Radiographs - Saddle Sign [actually seeing the spur, xray upside down looks like a saddle]
• Laboratory Studies - only if worrying about infection
• Bone Scans - if not responding to conservative tx, pain with compression of calcaneal tuberosity w/ increased activitiy hx
• MRI - looking for bone cyst, bone tumor

Question 5

heel spur

Answer 5

Question 6

tx options

Answer 6

• Taping (low dye)
• NSAIDs
• Ice
• Physical therapy (stetching PF, achilles)
• Orthotics
• Injections/Medrol Dose Pack (injection/oral with anti-inflammatory corticosteroids)
• Night splints or straussburg sock
• Immobilization
• Platelet-Rich Plasma (injection and trauma inducing)
• Surgery

Question 7

what is plantar fasciotomy?

Answer 7

• plantar fascial release with or without spur resection
• instep fasciotomy, open fasciotomy or endoscopic plantar fasciotomy (EPF)

Question 8

which plantar fasciotomy allows for spur resection?

Answer 8

only open fasciotomy

Question 9

describe instep fasciotomy

Answer 9

• Incision in medial arch anterior to calcaneus
• Medial portion of fascia released
• (+) recovery, visibility
• ( - ) no resection of exostosis

Question 10

describe open fasciotomy

Answer 10

• medial incision to visualize the plantar fascia
• fascia isolated superior and inferior
• (+) visibility, resection of exostosis
• ( - ) recovery (crutches 2-3 wks), wound complications, neurological complications (medial branch calcaneal). and hematoma

Question 11

describe endoscopic plantar fasciotomy

Answer 11

• use of an endoscope to visualize and cut the plantar fascia
• ( + ) recovery, visibility
• ( - ) no resection of exostosis