Treatment Of Heel Pain Research Articles

Percutaneous radiofrequency nerve ablation in patients with chronic heel pain

Background: Heel pain, known as fasciitis, runner’s heel, tennis heel, or police heel, can sometimes become challenging to manage. Many conservative methods, including stretching or orthosis, steroid injection, and extracorporeal shock wave therapy, are used in treating heel pain. This study investigated the therapeutic effect of percutaneous radiofrequency nerve ablation (RFNA) in treating patients with chronic heel pain.Methods: In this retrospective study, 78 (84 feet) patients with severe and chronic heel pain were included. Patients with heel pain related to calcaneal spur were resistant to conservative methods. Therefore, RFNA was performed on patients who met the criteria. Patients were assessed with a questionnaire and the visual analog scale (VAS) before and after the procedure.Results: The mean VAS results were 9.3 ± 0.8 before and 3.4 ± 2.6 six months after the procedure, with statistically significant change observed. (p<0.05) Furthermore, 79.2% of participants found RFNA favorable.Conclusions: According to the findings, we may say that RFNA successfully relieves chronic heel pain.

Treating Heel Pain in Adults: A Randomized Controlled Trial of Hard vs Modified Soft Custom Orthotics and Heel Pads

ObjectivesThis study compared the effectiveness of soft vs hard orthotics in treating heel pain and plantar fasciitis in adults. It also compared the level of function after orthotic use, cost, and number of visits for orthotics and explored whether age was a factor in orthotic effectiveness. DesignRandomized controlled trial. Before randomization, patients were stratified by age (younger vs older adults) in blocks of 4 to ensure that there were an equal number of participants in each group (soft vs hard orthotics). SettingAn orthotic clinic in a community-based hospital and a private orthotic clinic. ParticipantsThe participants were adults aged 18 years or older (N=44) with heel pain and plantar fasciitis. InterventionParticipants received hard or soft customized orthotics. Main Outcome MeasuresParticipants rated their pain intensity and pain interference before and after orthotic use using subscales from the Brief Pain Inventory. Function was similarly measured using the Late Life Function and Disability Instrument: Function component. Analyses of age, cost, and number of visits were also compared. ResultsThere was a reduction in pain intensity (P=.010) and pain interference (P<.001) but no change in function over time (P=.333), and no difference between the groups who received hard vs soft orthotics. Age had no effect on orthotic effectiveness. Soft orthotics were less expensive (P<.0001) and required fewer visits for fabrication (P<.0001). ConclusionBoth soft and hard orthotics provided effective pain relief, but soft orthotics are less expensive.

Plantar fasciitis: Evidence-based review of current treatment modalities

Various evidence based treatment options are available for the treatment of plantar fasciitis. This article is a review of recent literature comparing various treatment modalities used for the treatment of plantar fasciitis. This will assist health care providers to make a sound diagnosis and treatment of heel pain.

Analysis of characteristics of acupuncture diagnosis and treatment based on literature

Objective To explore the characteristics of diagnosis and treatment of acupuncture and moxibustion for heel pain. Methods We searched the literatures related to heel pain treated by acupuncture and moxibustion in CNKI, WFPD, VIP, CBM, PubMed and Embase, then summarized the intervene measures related to acupuncture and moxibustion, clinical characteristics of syndrome differentiation and acupuncture points selection method, frequency, treatment course, treatment effect, follow-up outcomes and safety. Results A total of 47 articles are included in the acupuncture treatment of heel pain commonly used measures like small needling knife, acupuncture, acupoint injection, electro-acupuncture, fire needling, warm needling and moxibustion. The percentage of article involved in treating heel pain by small needling knife was 55.32% (26/47) and 21.28% (10/47) by acupuncture. The percentage of articles involved in acupuncture points selection method by differentiation of disease was 93.62% (44/47). The main acupuncture points in the 47 articles was ashi acpoint (68.09%, 32/47). The therapy frequency and treatment courses varied from the differences of the acupuncture and moxibustion methods. For small needling knife, the percentage of treating frequency of one time was 36.17% (17/47) and evaluating the curative effect after one treatment was 40.43% (19/47). For acupuncture, the percentage of treating frequency of once a day was 17.02% (8/47) and 23.40% (11/47). The effective rate showed a lot of variation from 69.56%-100% vary by intervene measures. The follow-up rate was not high, only 27.66% (13/47). There was only one literature referring to the adverse reaction. Conclusions The literatures review showed that the small needling knife was the most frequent method, followed by acupuncture. Acupuncture points selection by disease differentiation is the common method. The main acupuncture points applied in heel pain is ashi acupoint. Evaluating the effect after one treatment was common used for small needling knife. Once a day and ten times a therapy course were the common treatment frequency and treatment course for the remaining intervene measures. Acupuncture and moxibustion could show immediate and probable long-term positive effect for heel pain without no severe adverse reactions. Key words: Heel pain; Acupuncture and moxibustion; Diagnosis and treatment; Medicine pharmacologic literature (TCM); Literature based discovery

Alternate hot and cold application in the management of heel pain: A pilot study

BackgroundDespite a long-standing tradition of naturopathic physical therapy and hydrotherapy use in the treatment of musculoskeletal conditions, neither naturopathy, nor specific aspects of hydrotherapy have been tested for efficacy in the treatment of heel pain. MethodsPatients (n=20) were assigned to standard naturopathic physiotherapy care (NPC) with two adjuvant therapy groups: a control group (therapeutic ultrasound, n=10), or alternating compresses (n=10). Pain scores were measured before and after treatment using Visual Analog Scale (VAS) and foot functionality was measured using the Foot Function Index (FFI). ResultsFFI reduced from 46.97 to 31.98 (p=0.005) among normal protocol patients and from 49.72 to 21.35 (p=<0.001) among patients receiving the alternating compress protocol. Average VAS pain intensity in the seven days of treatment decreased from 3.53 to 2.53cm (p=<0.001) among patients receiving NPC and from 4.09 to 2.61cm (p=<0.001) amongst those receiving NPC plus alternating compresses. There was no significant difference in pain score reduction between the two groups (p=0.206), but patients with alternating compresses as part of their treatment had significant improvements in foot functionality (p=0.007). DiscussionNaturopathic physical therapy significantly improves foot functionality and pain scores in heel pain. Additionally, alternating compresses improve foot functionality scores.

Диагностика и лечение пяточной боли в клинической практике

Диагностика и лечение пяточной боли в клинической практике

Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain

Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain

Clinical observation of Chinese herbal fumigation plus mulberry stick beating for heel pain

To observe the clinical efficacy of Chinese herbal fumigation plus beating with mulberry stick in treating heel pain. Sixty patients with heel pain were randomized into a treatment group and a control group, 30 in each group. The treatment group was intervened by Chinese herbal fumigation plus beating with mulberry stick, and the control group was by orally taking Diclofenac Sodium Sustained Release Tablets plus external use of She Xiang Zhen Tong Gao (Moschus Analgesic Plaster). After one treatment course, the visual analogue scale (VAS) was used to observe the change of pain, and the clinical efficacies were also evaluated. After intervention, the improvement of VAS score in the treatment group was more significant than that in the control group (P<0.01). The total effective rate of the treatment group was significantly higher than that of the control group (P<0.01). Chinese herbal fumigation plus beating with mulberry stick can produce a higher clinical efficacy than orally taking Diclofenac Sodium Sustained Release Tablets in treating heel pain.

Plantar Fasciitis: A Concise Review

One challenge in the treatment of plantar fasciitis is that very few high-quality studies exist comparing different treatment modalities to guide evidence-based management. Current literature suggests a change to the way that plantar fasciitis is managed. This article reviews the most current literature on plantar fasciitis and showcases recommended treatment guidelines. This serves to assist physicians in diagnosing and treating heel pain with plantar fasciitis.

Deep massage to posterior calf muscles in combination with neural mobilization exercises as a treatment for heel pain: A pilot randomized clinical trial

BackgroundPlantar heel pain syndrome (PHPS) is a common foot disorder; however, there is limited clinical evidence on which to base treatment. Repeated clinical observations indicating heel pain during heel rise and minisquat on the affected leg, involving activation of posterior calf muscles, formed the basis of this study. ObjectiveTo compare deep massage therapy to posterior calf muscles and neural mobilization with a self-stretch exercise program (DMS) to a common treatment protocol of ultrasound therapy to the painful heel area with the same self-stretch exercises (USS). MethodsPatients with PHPS were assigned to a program of 8 treatments over a period of 4–6 weeks in a single-blind randomized clinical trial. Functional status (FS) at admission and discharge from therapy as measured by the Foot & Ankle Computerized Adaptive Test was the main outcome measure. ResultsSixty-nine patients were included in the trial (mean age 53, standard deviation (SD) 13, range 25–86, 57% women), 36 received DMS treatment and 33 with USS. The overall group-by-time interaction for the mixed-model analysis of variance (ANOVA) was found statistically significant (p=0.034), with a change of (mean (confidence interval, CI)) 15 (9–21) and 6 (1–11) FS points for the DMS and USS groups, respectively. ConclusionsData indicated that both treatment protocols resulted in an overall short-term improvement, however, DMS treatment was significantly more effective in treating PHPS than USS treatment.

FRI0582-HPR Extracorporeal shock wave therapy versus low intensity laser therapy in the treatment of heel pain

BackgroundPlantar heel pain in adulthood is a common, disabling and chronic foot problem. Most cases have a biomechanical etiology however various systemic arthritis also causes heel pain. Plantar fasciitis which...

The Diagnosis and Treatment of Heel Pain: A Clinical Practice Guideline–Revision 2010

Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.

Cryosurgery for the Treatment of Heel Pain

Although cryosurgery has been used to treat certain conditions, its efficacy for the treatment of heel pain has not been established. The objective of this retrospective case series was to investigate both short- and long-term changes in heel pain after cryosurgery. A sample of 137 feet (n = 137) was analyzed over a 24-month period after cryosurgery. The mean age was 56 years and the mean BMI was 33. Subjects in our analysis included only those who had failed 6 months of conservative care prior to cryosurgery. Pain was measured using a Numeric Pain Scale (NPS, zero to 10) at 3 weeks and 24 months. Statistics were calculated using SPSS version 12.0 (Chicago, IL). A total of 106 subjects had successful pain relief and 31 subjects failed to gain relief; the success and failure rates were 77.4% and 22.6%, respectively. Mean pain before cryosurgery was 7.6, after cryosurgery at three weeks was 1.6 (p < 0.0005), and after cryosurgery at 24 months was 1.1 (p < 0.0005). In subjects who achieved successful pain relief, the significantly lower mean pain score at 3 weeks and 24 months, compared to the initial pain score prior to cryosurgery, suggests that cryosurgery was successful in resolving both short- and long-term heel pain.

Welcome to Sports Health!

Happy New Year and welcome to Sports Health! As we begin 2009, Sports Health has made one New Year’s resolution: to meet the need for a multidisciplinary, clinically based journal focused on the care of the competitive and recreational athlete. The American Orthopaedic Society for Sports Medicine’s (AOSSM) Executive Editor Bruce Reider, MD, Executive Director Irv Bomberger, Board of Directors, and Medical Publishing Board of Trustees, chaired by T. David Sisk, MD, identified this need a little more than 2 years ago and worked hard to create a journal that would meet it. This inaugural issue of Sports Health is a testament to their dedication and persistence. From neuropsych testing to foot care, Sports Health will strive to cover topics important to the care of the athlete from head to toe. Realizing that it would be very difficult for any one organization to make this goal a reality, I am very grateful to the organizations that have partnered with the AOSSM to bring this journal to life. Recognizing the needs that this journal could fulfill, the American Medical Society for Sports Medicine (AMSSM), the National Athletic Trainers’ Association (NATA), and the Sports Physical Therapy Section (SPTS) invested with the AOSSM in this effort. More recently, the American Academy of Pediatrics’ Council on Sports Medicine and Fitness and the American Osteopathic Academy of Sports Medicine have begun participation, emphasizing the diverse and expanding role that this journal could play in sports medicine. We look forward to the contributions of our collaborating partners and many more professional organizations in the future as we strive to make this journal complete. As we look to the future, no doubt the long-term value of this publication will be dependent upon the clinical and scientific value of its content. To help us hit that mark, we have selected 3 highly talented associate editors from our original collaborating organizations: George Davies, DPT, ACT, CSCS, from the SPTS, Matthew Gammons, MD, from the AMSSM, and Riann Palmieri-Smith, PhD, ATC, from the NATA. George brings a wealth of editorial expertise as he has long been an integral player in the SPTS. Matt is a very busy primary care clinician who is well aware of the challenges facing frontline sports practitioners. Riann is a skilled researcher with keen insight into the clinical challenges of athletic training. Because sports medicine in the 21st century is highly dependent upon imaging technology, we are very fortunate to feature Hollis Potter, MD, as the assistant editor for imaging. Hollis is a magnetic resonance expert, well known for her musculoskeletal expertise. The clinical challenges in sports medicine today are diverse and vary by sport and geography. Directing the interests of Sports Health to timely and pertinent topics will be our international editorial board. Yes, we are interested in and appreciate the complexity of sports medicine beyond North America and recognize that “football” is not played in a helmet and shoulder pads beyond our shores. We value international perspective and global knowledge and look forward to diverse participation from our colleagues abroad. For those of you who glanced at this first issue’s table of contents and thought that this was just another knee journal because the focus of this edition is the anterior cruciate ligament, allow me to assure you that it is not just another knee journal. Future editions will focus on the upper extremity, medical emergencies, training and rehabilitation issues, as well as featuring pertinent topics for the pediatric and the geriatric athlete. Substance abuse, cardiac emergencies, the clinical course of bone bruising and the treatment of heel pain are but a few of the upcoming features. Lastly, as for the format of the journal, I realize that many controversial and timely topics cannot be easily addressed through original research. While we will strive to maintain a scientific format and wish to emphasize evidence-based medical decision-making, we will incorporate features to address such controversies as game-day injections and the safety of medical products on the market today. Because separating opinion from scientific fact in clinical reviews can be challenging but helpful for the clinician, the Strength of Recommendation Taxonomy (SORT, developed by the American Academy of Family Physicians1) classification system will be a regular feature. This grading scale will be used to measure the strength of the evidence for clinical recommendations. My hope is that you will find this journal of great help in attending to the athletes entrusted to your care. I look forward to your input on how we can continuously achieve this goal.

Efficacy of cryosurgery in the treatment of heel pain

Efficacy of cryosurgery in the treatment of heel pain

Diagnosis and treatment of heel pain.

The American College of Foot and Ankle Surgeons (ACFAC) clinical practice guideline (CPG) summarizes the literature on the assessment and diagnosis of heel pain. The framework classifies heel pain depending on whether the cause is mechanical, neurological, arthritic, traumatic, or from another origin. Treatment strategies are included for the most common form of heel pain that are caused by mechanical problems.

Extracorporeal shock wave therapy.

Extracorporeal shock wave therapy (ESWT) is an emerging treatment modality for managing pain caused by various musculoskeletal disorders. According to recent systematic reviews by Crawford et al and Odgen et al, evidence is accumulating to support the use of ESWT as an effective treatment for heel pain. The US Food and Drug Administration has, in fact, approved the use of the electrohydraulic OssaTron (High Medical Technology, Kreuzlingen, Switzerland) for the treatment of plantar fasciitis. The results of a meta-analysis by Odgen et al demonstrated that, of various applications of ESWT on musculoskeletal conditions, the use of ESWT for treating plantar fasciitis was the most credible. As ESWT may become a new and popular treatment for managing heel pain and possibly other musculoskeletal disorders, the purpose of this paper is to review the background knowledge of ESWT and to describe the technical details of this new modality in treating heel pain. J Orthop Sports Phys Ther. 2003; 33(6):337–343.

Preliminary results on the safety and efficacy of the OssaTron for treatment of plantar fasciitis.

The OssaTron may be another alternative for management of plantar fasciitis (heel pain syndrome) after failure of non-operative management and prior to surgical management. This study evaluated primarily the safety and early preliminary efficacy of the OssaTron in treatment of patients with plantar fasciitis unresponsive to non-operative management. Twenty heels of 20 patients were treated with 1000 extracorporeal shockwaves from the OssaTron to the affected heel after administration of a heel block. The patients were followed for one year. Each patient was evaluated by roentgenogram, KinCom, range of motion and physical examination, including evaluation of point tenderness by means of a palpometer and according to a 10-cm visual analog scale. The control was the contralateral heel. Patients also performed self evaluation by means of patient activities of daily living questionnaire and pain reported by a 10-cm visual analog scale. There were no complications or adverse effects attributed to the procedure of orthotripsy. Of the 20 patients treated, 18 were improved or pain-free. Eighteen of the 20 subjects treated stated that they would undergo the procedure again instead of surgery. Based on these results, we concluded that orthotripsy is a safe and effective method of treating heel pain syndrome that has been unresponsive to nonoperative management.

The diagnosis and treatment of heel pain

Mechanical heel pain is one of the most frequent conditions presented to foot and ankle specialists. Plantar heel pain is responsible for the majority of mechanical heel pain cases. Plantar heel pain is defined as insertional heel pain of the plantar fascia with or without a heel spur (Fig. 1). The most common cause cited for plantar heel pain is biomechanical abnormalities that lead to pathologic stress to the plantar soft tissues (1–7). Localized nerve entrapment of the medial calcaneal or muscular branch off the lateral plantar nerve may be a contributing factor (8–11). Patients usually present with isolated plantar heel pain upon initiation of weightbearing, either in the morning upon arising or after sitting for a period of rest. The pain tends to decrease after a few minutes, then returns as the day proceeds and time on the feet increases. Associated significant findings may include high body mass index, tightness of the Achilles tendon, pain upon palpation of the inferior heel, and inappropriate shoe wear (12–14). Many patients will have attempted self-remedies before seeking medical advice. A careful history is important, including time(s) of day when pain occurs, current shoe wear, activity level both at work and at leisure, and history of trauma. An appropriate physical examination of the lower extremity includes range of motion of the ankle with special attention to decreased range of motion of dorsiflexion of the ankle, palpation of the inferior medial aspect of the heel, palpation of the medial aspect of the heel, the occurrence of bilateral symptoms, and angle and base of gait evaluation. Following physical evaluation, appropriate radiographs may be considered. Radiographic identification of a plantar heel spur indicates that the condition has been present for at least 6–12 months, whether having been symptomatic or not (Fig. 2). As a rule, the longer the duration of heel pain symptoms, the longer the period to final resolution of the condition. Initial treatment options may include nonsteroidal antiinflammatory drugs (NSAIDs), padding and strapping of the foot, and corticosteroid injections for appropriate patients. Patient-directed treatments seem to be as important in resolving symptoms. They include regular stretching of the calf muscles, avoidance of flat shoes and barefoot walking, use of cryotherapy directly to the affected part, over-the-counter arch supports and heel cushions, and limitation of extended physical activities. Patients usually have a clinical response within 6 weeks of initiation of treatment. If improvement is noted, the initial therapy program is continued until symptoms are resolved. If no improvement is noted, the patient should be referred to a podiatric foot and ankle surgeon. The second phase of treatment for the referred patient includes continuation of the initial treatment options with considerations for additional therapy: the use of custom orthotic devices, especially in the biomechanically malaligned patient, the use of night splints to

Management of heel pain syndrome with acetic acid iontophoresis.

This study was undertaken to determine the effectiveness of acetic acid iontophoresis in the treatment of heel pain. Thirty-five patients with chronic heel pain were treated with acetic acid iontophoresis over a 4-year period. Ninety-four percent of patients had complete or substantial relief of heel pain after an average of 5.7 sessions of acetic acid iontophoresis over an average period of 2.8 weeks. Heel pain levels were rated from 0 to 10, with 10 representing the most severe pain. Heel pain prior to iontophoresis treatment received an average rating of 7.5; by the end of therapy, the average rating had decreased to 1.8. At an average follow-up time of 27 months, heel pain levels averaged 0.64, indicating continued reduction in heel pain. Ninety-four percent of participants said that they would recommend acetic acid iontophoresis to someone with similar heel pain.