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MODERN RHEUMATOLOGY Vol.15 No.5

Vol.15 No.5 に戻る

REVIEW ARTICLE
Plantar heel pain and its 3-mode 4-stage treatment

Full Text (PDF)

Oliver Michelsson1, Yrjo T. Konttinen2, 3, 4, Pekka Paavolainen3 and Seppo Santavirta1

(1) Department of Orthopaedics and Traumatology, Helsinki University Central Hospital, Topeliuksenkatu 5, FIN-00260 Helsinki, Finland
(2) Department of Medicine, Helsinki University Central Hospital, Helsinki, Finland
(3) ORTON Orthopaedic Hospital of the Invalid Foundation, Helsinki, Finland
(4) COXA Hospital for Joint Replacement, Tampere, Finland

Received: 18 May 2005 Accepted: 26 July 2005

Abstract The most common cause for heel pain is plantar fasciitis. The diagnosis can usually be made by clinical examination, but sometimes ENMG (electroneuromyography), ultrasound, and magnetic resonance imaging examinations are helpful. Other reasons for heel pain, e.g., nerve entrapments, atherosclerosis/ischemia, and fat pad degeneration, should be excluded. Plantar fasciitis can also present a symptom of chronic seronegative spondyloarthropathies or reactive arthritis. In the case of common plantar fasciitis, three different modes of treatment can be administered, namely, (1) anti-inflammatory and analgesic treatment, (2) rest and diminution of the strain at the insertion, and (3) maintenance of the tension and flexibility of the soft tissues. A simple four-step treatment plan algorithm, based on symptoms, their duration, and response to treatment, is presented. Operative treatment is seldom needed if the algorithm is correctly followed. Operative treatment is recommended only when the pain remains resistant to conservative treatment after more than 1 year. For operative treatment, partial release of the fascia close to insertion to avoid flat foot and secondary strain on the calcaneocuboid and midtarsal (Lisfranc) joints is our preferred option.

Key words Enthesopathy - Fasciitis - Heel pain - Treatment

 

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