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Heel Pain
Clin Podiatr Med Surg 22 (2005) xiii – xiv
Preface
Heel Pain
Thomas Zgonis, DPM, AACFAS Gary Peter Jolly, DPM, FACFAS Guest Editors
Perhaps the most common presenting complaint that foot and ankle surgeons hear is that of heel pain. It has been reported to be responsible for 20% of the new patients seen in foot and ankle surgery practices. Despite its frequency, chronic heel pain continues to be a poorly understood set of clinical entities whose treatment is usually empiric and nonsystematic. Historically, patients who presented with heel pain with the first steps in the morning were thought to have painful heel spurs, despite the sometimes unsettling absence of radiographic findings. Eventually, the focus of the etiology shifted to the plantar fascia, where it remains today as the most frequently diagnosed cause of heel pain. Treatment regimens for chronic heel pain vary from surgeon to surgeon and seem to lack any cohesive pattern, reflecting an absence of consensus on just how to treat these patients. Although anecdotal evidence abounds, little in the way of meaningful, double blind, prospective trials have been published, making it difficult for practitioners to effectively treat these patients with anything approaching real confidence. In addition to plantar fascitis, neurogenic causes have been identified as etiologies, as have various enthesopathies. Unfortunately, the actual frequencies for these various etiologies remain unknown. Heel pain is a symptom and nothing more. However, it is not uncommon for patients with heel pain to be treated without a clear understanding of what has produced the symptoms. This is akin to a general surgeon treating a patient for abdominal pain without knowing what caused it. To treat any condition ef0891-8422/05/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.cpm.2004.08.010 podiatric.theclinics.com
xiv
T. Zgonis, G.P. Jolly / Clin Podiatr Med Surg 22 (2005) xiii–xiv
fectively, the condition must be identified, and to identify the condition, an adequate history should be taken, and a thorough physical examination needs to be performed. The use of bwaste basketQ terms such as heel spur syndrome or the presumptive diagnosis of plantar fascitis should be avoided so as not to fall into the habit of treating bwaste basketQ entities, whose response to nonspecific therapy is less likely to produce satisfactory results. Clearly, heel pain associated with compression of the medial calcaneal nerve responds differently than that which is caused by an inflammatory lesion of the plantar fascia. There are other conditions that produce heel pain, such as stress fractures, tumors, collagen vascular diseases (which produce inflammatory connective tissue disorders), and primary tendon disorders. To effectively treat patients with heel pain, it is essential that the surgeon have a thorough knowledge of all the ills that the human heel is heir to. It is our hope that this edition, with the meaningful contribution of its authors, will codify for the reader a complete and systematic approach to patients with heel pain. Thomas Zgonis, DPM, AACFAS Gary Peter Jolly, DPM, FACFAS Connecticut Reconstructive Foot Surgeons 21 Woodland Street Suite 221, Hartford, CT 06105, USA E-mail addresses: [email protected] (T. Zgonis) [email protected] (G.P. Jolly)
Preface
Heel Pain
Thomas Zgonis, DPM, AACFAS Gary Peter Jolly, DPM, FACFAS Guest Editors
Perhaps the most common presenting complaint that foot and ankle surgeons hear is that of heel pain. It has been reported to be responsible for 20% of the new patients seen in foot and ankle surgery practices. Despite its frequency, chronic heel pain continues to be a poorly understood set of clinical entities whose treatment is usually empiric and nonsystematic. Historically, patients who presented with heel pain with the first steps in the morning were thought to have painful heel spurs, despite the sometimes unsettling absence of radiographic findings. Eventually, the focus of the etiology shifted to the plantar fascia, where it remains today as the most frequently diagnosed cause of heel pain. Treatment regimens for chronic heel pain vary from surgeon to surgeon and seem to lack any cohesive pattern, reflecting an absence of consensus on just how to treat these patients. Although anecdotal evidence abounds, little in the way of meaningful, double blind, prospective trials have been published, making it difficult for practitioners to effectively treat these patients with anything approaching real confidence. In addition to plantar fascitis, neurogenic causes have been identified as etiologies, as have various enthesopathies. Unfortunately, the actual frequencies for these various etiologies remain unknown. Heel pain is a symptom and nothing more. However, it is not uncommon for patients with heel pain to be treated without a clear understanding of what has produced the symptoms. This is akin to a general surgeon treating a patient for abdominal pain without knowing what caused it. To treat any condition ef0891-8422/05/$ – see front matter D 2004 Elsevier Inc. All rights reserved. doi:10.1016/j.cpm.2004.08.010 podiatric.theclinics.com
xiv
T. Zgonis, G.P. Jolly / Clin Podiatr Med Surg 22 (2005) xiii–xiv
fectively, the condition must be identified, and to identify the condition, an adequate history should be taken, and a thorough physical examination needs to be performed. The use of bwaste basketQ terms such as heel spur syndrome or the presumptive diagnosis of plantar fascitis should be avoided so as not to fall into the habit of treating bwaste basketQ entities, whose response to nonspecific therapy is less likely to produce satisfactory results. Clearly, heel pain associated with compression of the medial calcaneal nerve responds differently than that which is caused by an inflammatory lesion of the plantar fascia. There are other conditions that produce heel pain, such as stress fractures, tumors, collagen vascular diseases (which produce inflammatory connective tissue disorders), and primary tendon disorders. To effectively treat patients with heel pain, it is essential that the surgeon have a thorough knowledge of all the ills that the human heel is heir to. It is our hope that this edition, with the meaningful contribution of its authors, will codify for the reader a complete and systematic approach to patients with heel pain. Thomas Zgonis, DPM, AACFAS Gary Peter Jolly, DPM, FACFAS Connecticut Reconstructive Foot Surgeons 21 Woodland Street Suite 221, Hartford, CT 06105, USA E-mail addresses: [email protected] (T. Zgonis) [email protected] (G.P. Jolly)