A Closer Look At Treating Plantar Fasciitis

   There is no doubt that podiatrists see quite a bit of heel pain. Plantar fasciitis accounts for 11 to 15 percent of all foot symptoms in adults, according to an article published in the New England Journal of Medicine last year. As Stephen Barrett, DPM, points out in his cover story, “A Guide To Neurogenic Etiologies” (see page 36), projected estimates indicate that greater than two million patients per year are diagnosed with heel pain in the United States.    However, despite the prevalence of this condition, there are complex anatomical considerations. According to the American Podiatric Medical Association, “the heel bone is the largest of the 26 bones in the foot, which also has 33 joints and a network of more than 100 tendons, muscles and ligaments.” As Doug Richie, Jr., DPM, acknowledges in his article, “Offloading The Plantar Fascia: What You Should Know” (see page 46), the etiology of plantar fasciitis also remains elusive.     “Most experienced practitioners report that heel pain complaints have risen to epidemic proportion over the past 20 years for reasons we still do not fully understand,” notes Dr. Richie.    With these points in mind, we present our Sixth Annual Heel Pain Theme Issue.    Drs. Barrett and Richie both cite the 2003 study by Harvey Lemont, DPM, and colleagues in the Journal of the American Podiatric Medical Association. The histologic findings from 50 cases of heel spur surgery for chronic plantar fasciitis supported the notion of plantar fasciitis as more of a degenerative fasciosis without inflammation as opposed to fasciitis.    As Dr. Barrett asserts in his article, the emergence of these studies and multiple etiology heel pain signals a significant shift in the understanding of this prevalent condition. Accordingly, he discusses the use of a heel pain scoring system and a diagnostic algorithm that clinicians could potentially use when they have a high index of suspicion for heel pain that may have a neurogenic etiology.    In a thorough review of the literature and his own experience, Dr. Richie challenges conventional assumptions about the use of custom orthoses for plantar fasciitis. He also offers salient biomechanical and anatomical insights that may facilitate improved dialogue between clinicians and orthotic laboratories, and ultimately lead to more effective orthotic prescriptions.    In keeping with the magazine’s ongoing quest to provide practical, clinical tips one can utilize in practice, Lisa Schoene, DPM, provides an illuminating view with her feature article, “A Stepwise Approach To Treating Chronic Heel Pain” (see page 58).    Dr. Schoene emphasizes that podiatrists are the experts when it comes to acute foot pain. She offers a glimpse at her treatment recipe for treating chronic heel pain and how the recipe is altered or changed through the proper progression of care for these patients. Accordingly, she takes the reader through four follow-up visits for three patients with varying responses to treatment. This unique approach to a feature article seems to capture the day-to-day details in treating this condition.    Rounding out the theme issue is our continuing education feature, “How To Evaluate And Treat Calcaneal Fractures,” which is authored by Don Buddecke, DPM, and Michael S. Lee, DPM. In their article (see page 75), Drs. Buddecke and Lee emphasize that a thorough knowledge of the calcaneal anatomy is essential to diagnosing and treating “one of the most complicated injuries of the lower extremity.” They proceed to offer insights on the diagnostic workup of this condition as well as key surgical pearls and important postoperative considerations.    Hopefully, the variety of clinical features in this theme issue will provide practical and useful insights in the differential diagnosis and treatment of the highly prevalent but complex condition of plantar fasciitis (or fasciosis).