Thursday, January 21, 2016
Diagnosing and treating Heel Pain with Diagnositic Ultrasound
One of the most common foot conditions that we see at Carolina Foot Specialists is heel pain. . Researchers have reported that plantar fasciitis occurs in 2 million Americans a year and 10 percent of the population over a lifetime.3
It is important to understand that not all heel pain is the classic, “Plantar Fasciitis.” The differential diagnosis may also include Achilles tendinitis, autoimmune inflammatory syndromes, stress fractures, nerve entrapment, apophysitis, arterial insufficiency, tarsal tunnel syndrome, infection, bursitis, fat pad atrophy, trauma, and simply overuse syndrome.
Dr. Saffer and Dr. Brown have been utilizing diagnostic Ultrasound for the past 10 years. When it comes to the use of ultrasound in the diagnosis of plantar fasciitis, our Sports Podiatrists firmly believe it is easy to perform, in-office, and can aid in diagnosing the specific form of foot or heel pain that is presented.
Ultrasound has afforded our practice the ability to diagnose fasciitis, fasciosis, plantar fascial tears, inferior calcaneal bursitis, cortical stress fractures and abscesses (with a vertical toothpick embedded in the calcaneus). If a cortisone injection is required especially for plantar fasciitis/plantar fasciosis our specialists have a virtual pain free technique and are able to directly visualize the injection pinpointing the area of pathology. This is all done in the office setting and typically takes a few minutes.
We feel that the gold standard for evaluating heel pain in the office setting is Diagnostic Ultrasound. If x-rays are needed we have that technology in our offices as well.
Once you become comfortable with the modality, you will soon realize that the placement of your injections without ultrasound guidance can be “misguided.” In our experience, we realized that at times were were not placing injections deep enough into the tissue and often injected at a site that did not house the inflammatory changes. Needless to say, missing the target will not net optimal results Additionally, if you are injecting steroid into an area of “non-pathology,” you run the risks of possible injection into the subcutaneous tissue which could lead to fat pad atrophy
Once you become comfortable with the modality, you will soon realize that the placement of your injections without ultrasound guidance can be “misguided.” In my own experience, I realized I was not placing my injections deep enough into the tissue and often injected at a site that did not house the inflammatory changes. When you depend on patients’ subjective experience as to where the maximum pathology exists via palpation, you soon find that they often will report pain in an area adjacent to and at other times distant from the actual site of pathology. Needless to say, missing the target will not net optimal results.
Additionally, if you are injecting steroid into an area of “non-pathology,” you run the risks of the effects of local fibrolysis of the fascia and/or the subcutaneous tissue (fat pad atrophy).
Our practice is moving into newer minimally invasive technology for chronic heel pain. Our Sports Podiatrist have been trained in the “Percutaneous Plantar Fasciotomy.” This procedure is developed by Tenex and is a minimal incision that removes diseased tissue. No sutures are required and can be done under local or IV sedation at a surgery center or hospital. For more information on diagnostic Ultrasound and Tenex please our Heel Pain Center at Carolinafootspecialists.net.