The guidelines from the New York State workers’ compensation board are here to support doctors, podiatrists, and healthcare experts in giving the right treatment for Plantar Heel Pain.
Healthcare professionals can rely on these guidelines from the Workers’ Compensation Board to figure out the best care for patients dealing with ankle and foot issues.
It’s important to note that these guidelines don’t replace the wisdom and expertise of healthcare professionals. The final decision about care should be a collaborative effort between the patient and their healthcare provider.
Plantar Heel Pain (“Plantar Fasciitis”)
The heel is the usual suspect when it comes to foot pain. Plantar fasciitis, or plantar heel pain, goes by various names like runner’s heel, painful heel syndrome, and more.
Plantar fasciitis typically brings on intense discomfort in the lower or plantar part of the middle heel. You might also feel pain towards the arch of the foot. It hits hardest during weight-bearing activities, especially that first step in the morning or after sitting for a while.
The good news is, over 90% of folks dealing with plantar fasciitis find relief without surgery within six to twelve months. Conservative care works like a charm for plantar heel pain.
We start with non-invasive treatments for plantar heel pain. In about six to twelve months, these methods work their magic for over 90% of cases. And here’s a reassuring tidbit: tell the patient that 95% of people with plantar fasciitis get relief within 12 to 18 months—crucial info for non-surgical treatment.
Diagnostic Studies for Plantar Heel Pain in workers compensation patients
Checking for Plantar Heel Pain with X-Rays When it comes to figuring out what’s causing your plantar heel pain, using X-rays is a good call, especially if there’s a chance of fractures.
Why: X-rays help us dig deeper into the root of heel pain, ruling out other potential causes like fractures or bone tumors. But here’s the scoop—just going for regular videos to spot heel spurs isn’t the way to go.
MRI for Pinpointing Plantar Fasciitis in Specific Cases If you’re dealing with persistent heel discomfort, getting an MRI is a smart move, especially for specific cases of plantar fasciitis.
When: If your heel isn’t getting any better, there’s a chance the plantar fascia is in trouble, or the talar dome is facing blood supply issues, or there’s a stress fracture in the talar neck.
Why: MRI helps us explore beyond just plantar fasciitis—things like calcaneal stress fractures, ruptured plantar fascia, fluid around the fascia, and heel spurs all show up on the radar. Plus, it’s a handy tool for spotting ganglion cysts, joint fluid, avascular necrosis of the talar dome, and stress-induced osteoid tumors and talar neck fractures.
SPECT-CT: Not the Go-To for Plantar Fasciitis Diagnosis When it comes to diagnosing plantar heel pain, SPECT-CT isn’t the recommended go-to method.
Ultrasound: A Smart Move for Pinpointing Plantar Fasciitis For those tricky cases of plantar fasciitis, ultrasound is the way to go.
When: If the diagnosis isn’t crystal clear or your heel isn’t getting better after a month-long conservative treatment, it’s time to bring in the ultrasound.
Why: Ultrasound helps in cases where there might be a suspected plantar fascia rupture or plantar calcaneal bursitis, especially if the symptoms linger after trying non-invasive treatments.
Medications for Plantar Heel Pain
First-Line Pain Relief: Ibuprofen, Naproxen, and Older NSAIDs
For most patients, starting with ibuprofen, naproxen, or other older NSAIDs is the go-to for tackling pain. If NSAIDs aren’t an option, acetaminophen (or paracetamol) could work, even though studies suggest it’s just slightly less effective than NSAIDs.
Proof points to NSAIDs being safer and equally effective as opioids like tramadol when it comes to managing pain.
Using NSAIDs for Plantar Fasciitis Pain
When it comes to dealing with acute, subacute, chronic, or postoperative pain from plantar fasciitis, the recommendation is NSAIDs.
When: NSAIDs are the go-to for all stages of plantar fasciitis pain, be it right after it hits or in the long-term recovery post-surgery. Start with over-the-counter meds to test the waters.
How Much/How Often: Take NSAIDs as needed, and many patients find this approach reasonable.
When to Stop: Stop if the foot or ankle discomfort fades away, if the medication isn’t working, or if side effects pop up that call for discontinuation.
NSAIDs for High-Risk Gastrointestinal Bleeding
For individuals at a higher risk of gastrointestinal bleeding, using NSAIDs should be done cautiously. It’s recommended to simultaneously use cytoprotective drugs like misoprostol, sucralfate, H2 receptor blockers, or proton pump inhibitors.
When: Consider cytoprotective drugs for those at a high risk of gastrointestinal bleeding who also need NSAIDs, especially if the treatment plan is long-term. This is crucial for patients with a history of gastrointestinal bleeding, the elderly, diabetics, and smokers.
How Much/How Often: Follow the dosage recommendations for H2 blockers, misoprostol, sucralfate, and proton pump inhibitors. Generally, there’s no significant difference in their effectiveness in preventing gastrointestinal bleeding.
When to Stop: Discontinue if there’s intolerance, unwanted effects emerge, or if the NSAID is no longer needed.