As heel pain continues to be one of the most prevalent foot problems affecting men and women of all ages, the American College of Foot and Ankle Surgeons (ACFAS) published a new clinical practical guideline to help physicians diagnose and treat the numerous conditions associated with it.

Appearing as a supplement to the May/June Issue of the Journal of Foot & Ankle Surgery, the guideline is a revision of the original 2001 document and presents the latest clinical practices and review of the literature available on heel pain and its etiology.

"While most heel pain is still a result of a biomechanical condition or predisposition in the foot, the guideline has been expanded to help physicians distinguish cases that are more neurological, traumatic or arthritic in nature and require more specialized care," said the guideline's lead author James L. Thomas, DPM, FACFAS, a foot and ankle surgeon and associate professor of orthopaedics at West Virginia University School of Medicine. "A thorough assessment by a physician is key to proper diagnosis and treatment."

The most common diagnosis related to heel pain remains plantar fasciitis, a condition caused by chronic inflammation of the connective tissue extending from the heel to the toes, but heel pain can also be a result from other conditions such as:

-- Haglund's deformity, a bony enlargement on the back of heel which can cause the soft tissue near the Achilles tendon to become irritated when it rubs against shoes

-- Bursitis, an inflammation of the bursa (a fluid-like sac between the tendon and bone in the heel) often caused by the rubbing of a Haglund's deformity.

In most cases, these forms of heel pain can be treated with anti-inflammatory medications, stretching exercises, padding and strapping, and shoe modifications.

"The vast majority of patients with these types of heel pain improve without surgery, but early intervention is critical for optimal success," Dr. Thomas states. "If improvement occurs, the guideline specifies that initial therapy should continue until the pain is resolved. But if no relief is experienced, the patient should be referred to a foot and ankle surgeon for further evaluation to rule out other conditions such as circulation problems, arthritis, neurological conditions or stress fractures that may require advanced treatments, such as custom orthotics, corticosteroid injections or surgery," he adds.

Source: American College of Foot and Ankle Surgeons