Clinical Practice GuidelineThe Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010
Section snippets
Heel Pain (Pathway 1)
The heel is a frequent area of pathology. Pain in the heel may be the result of arthritic, neurologic, traumatic, or other systemic conditions, although the overwhelming cause is mechanical in origin. Careful history and examination are generally indicative of etiology and appropriate diagnostic testing will lead to accurate diagnosis. Treatment is directed toward causative factors.
Plantar Heel Pain [Plantar Fasciitis, Plantar Fasciosis, Heel Spur Syndrome] (Pathway 2)
Plantar heel pain is the most prevalent complaint presenting to foot and ankle specialists and may be seen in upwards of 11% to 15% of adults (1). Plantar heel pain has been referred to in the published literature by many names including heel spur syndrome, which lends some importance to the radiographic presence of an inferior calcaneal spur to the clinical symptoms. The term plantar fasciitis has been used for years, likely in an attempt to recognize the actual symptoms occurring along the
Posterior Heel Pain (Pathway 3)
The posterior heel is the second most common location of mechanically induced heel pain. Pathology in this area is categorized as (1) Achilles insertional tendinopathy or enthesopathy, and (2) Haglund's deformity with or without retrocalcaneal bursitis (Figure 6).
Achilles enthesopathy most commonly presents with an insidious onset and frequently leads to chronic posterior heel pain and swelling 219, 220, 221. Pain is aggravated by increased activity (eg, walking, running) and increased pressure
Neurologic Heel Pain (Pathway 4)
Neurologic heel pain is defined as pain in the heel as a result of an entrapment or irritation of one or more of the nerves that innervate this region. Symptoms may arise in patients initially diagnosed with plantar fasciitis, and careful assessment may yield neurologically mediated pathology 32, 297, 298. Patients with a history of previous heel surgery or trauma should be highly suspect for neurologic heel pain 299, 300. The nerves or nerve branches (Figure 8) specifically considered are as
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Financial Disclosure: None reported.
Conflict of Interest: Dr. Weil discloses consultant, advisory, and legal expert roles, as well as research funding, in association with ArthroCare Corporation, Orthometrix Inc., and Electro Medical Systems SA. Dr. Bouché discloses a proprietary interest in United Shockwave Therapies, LLC. Dr. Vanore discloses a consultant/advisory role with BME-TX and Ascension Orthopedics, stock ownership in BME-TX, and receipt of honoraria from BME-TX.
Supplement to: The Journal of Foot & Ankle Surgery®