Guidelines for Treatment of Chronic and Acute Heel Pain

Author: Monica Preboth
Date: May 15, 2002

The American College of Foot and Ankle Surgeons (ACFAS) has released new clinical guidelines to assist physicians in the diagnosis and treatment of chronic and acute heel pain. The guidelines were developed after extensive evaluation of current treatment methods and success rates, and a thorough review of the medical literature.

The ACFAS guidelines are intended to help physicians differentiate types of heel pain that can be treated conservatively from those that require more specialized care. The five basic types of heel pain are as follows:

* Mechanical. This is one of the most frequent conditions seen by foot and ankle subspecialists. An estimated 15 percent of all adult foot complaints involve mechanical heel pain caused by plantar fasciitis.

* Mechanical Posterior. This is the second most common type of mechanically induced heel pain, caused by inflammation of the Achilles tendon and bursitis.

* Neurologic. Neurologic heel pain can be caused by irritation of one or more of the nerves in the region.

* Arthritic. Arthritis can present as heel pain. Patients with arthritic heel pain usually have other joint problems as well.

* Traumatic Heel Pain. This type of pain is usually caused by fractures in the hindfoot area.

According to the ACFAS guidelines, plantar fasciitis should first be treated conservatively following physical examination and radiography. Initial treatment may involve anti-inflammatory drugs, padding and strapping of the foot, and corticosteroid injections. Patients should also be advised to stretch their calf muscles regularly, avoid wearing flat shoes and walking barefoot, use over-the-counter arch supports and heel cushions, and limit the frequency of extended physical activities.

Copies of the guidelines are available from the ACFAS by calling 847-292-2237.

COPYRIGHT 2002 American Academy of Family PhysiciansCOPYRIGHT 2002 Gale Group

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