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Plantar and Medial Heel Pain: Diagnosis and Management

Lareau, Craig R. MD; Sawyer, Gregory A. MD; Wang, Joanne H. BA; DiGiovanni, Christopher W. MD

JAAOS - Journal of the American Academy of Orthopaedic Surgeons: June 2014 - Volume 22 - Issue 6 - p 372–380
doi: 10.5435/JAAOS-22-06-372
Review Article

Heel pain is commonly encountered in orthopaedic practice. Establishing an accurate diagnosis is critical, but it can be challenging due to the complex regional anatomy. Subacute and chronic plantar and medial heel pain are most frequently the result of repetitive microtrauma or compression of neurologic structures, such as plantar fasciitis, heel pad atrophy, Baxter nerve entrapment, calcaneal stress fracture, and tarsal tunnel syndrome. Most causes of inferior heel pain can be successfully managed nonsurgically. Surgical intervention is reserved for patients who do not respond to nonsurgical measures. Although corticosteroid injections have a role in the management of select diagnoses, they should be used with caution.

From the Alpert Medical School, Brown University, Providence, RI (Dr. Lareau, Dr. Sawyer, and Ms. Wang), the Rhode Island Hospital, Providence (Dr. Lareau and Dr. Sawyer), and Harvard Medical School and the Massachusetts General Hospital, Boston, MA (Dr. DiGiovanni).

Dr. Sawyer or an immediate family member serves as a paid consultant to Mitek. Dr. DiGiovanni or an immediate family member has received royalties from Extremity Medical; is a member of a speakers’ bureau or has made paid presentations on behalf of BioMimetic Therapeutics, Extremity Medical, and Wright Medical Technology; serves as a paid consultant to BESPA, BioMimetic Therapeutics, Extremity Medical, and Wright Medical Technology; has stock or stock options held in Extremity Medical and Wright Medical Technology; has received research or institutional support from BioMimetic Therapeutics and Wright Medical Technology; and has received nonincome support (such as equipment or services), commercially derived honoraria, or other non–research-related funding (such as paid travel) from CuraMedix and Performance Orthotics. Neither of the following authors nor any immediate family member has received anything of value from or has stock or stock options held in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Lareau and Ms. Wang.

© 2014 by American Academy of Orthopaedic Surgeons
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