Home Forums Marketplace Table of Contents Events Member List Site Map Register Mark Forums Read



Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

If you have any problems with the registration process or your account login, please contact contact us.


Tags:

Heel Spur vs. Plantar Fasciitis: Patient Education

Reply
Submit Thread >  Submit to Digg Submit to Reddit Submit to Furl Submit to Del.icio.us Submit to Google Submit to Yahoo! This Submit to Technorati Submit to StumbleUpon Submit to Spurl Submit to Netscape  < Submit Thread
 
Thread Tools Display Modes
  #1  
Old 21st August 2007, 11:42 PM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Heel Spur vs. Plantar Fasciitis: Patient Education

Podiatry Arena members do not see these ads
Hi All,

I currently have a patient who presented with heel pain, and, to spare you all of the boring details, I diagnosed plantar fasciitis and went about the usual process of explaining to the patient the cause, short term treatment and long term treatment options.

This patient was accompanied by Xrays that were previously ordered by the GP showing a large plantar spur, and the GP wants to inject with cortisone. The patient is reluctant to have this treatment and therefore sought Podiatry advice hoping for a "milder" alternative (orthoses anyone?).

The patient so far has responded well to short term treatment of ice/tape/supportive shoes, and I have discussed long term treatment with orthoses and how they can help reduce tensile stress on the plantar fascia etc etc, however, she still seems convinced that the spur is the cause of her pain and that cushioning the spur (perhaps with a donut pad as she suggested ) will solve her heel pain. I have tried to explain that the spur has formed as a result of the ligament tensile force over time, but I feel that I am going around in circles explaining the "hows" and "whys" of the pathomechanics and treatment, and no matter how much I simplify my explanation, she still doesn't seem to understand... :(

My questions is, how do other pods explain to the patient the difference between plantar fasciitis and heels spurs? How much do you simplify your explanation? I normally use fairly basic terms and show the patient the skeleton model and diagrams on anatomy posters so the patient can try and visualise their condition...

What else is there?

Regards

Donna :)
Reply With Quote
Sponsored Links
  #2  
Old 21st August 2007, 11:50 PM
Craig Payne's Avatar
Craig Payne Craig Payne is offline
Moderator
Professor of Life, The Universe and Everything
 
About:
Join Date: Aug 2004
Location: Melbourne, Australia
Posts: 5,017
Join Date: Aug 2004
Marketplace reputation 0% (0)
Thanks: 100
Thanked 878 Times in 604 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

To me, its just not worth the effort. I just lie to them and tell them its a heel spur and hope they don't see this Is a calcaneal spur in the plantar fascia?
__________________
Craig Payne
__________________________________________________ ___________________________________
Follow me on Twitter | Run Junkie | Latest Blog Post: Review of Lieberman et al’s (2010) paper in Nature on Barefoot Running
God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.
Reply With Quote
  #3  
Old 22nd August 2007, 01:25 AM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Hi Craig,

Maybe I should make her some functional orthoses with a nice juicy heel pad to "help the spur"... :p

I'm going to try for the third time to explain it to her again when I see her on Friday...

Regards

Donna
Thread Starter
Reply With Quote
  #4  
Old 22nd August 2007, 02:19 AM
Robertisaacs's Avatar
Robertisaacs Robertisaacs is offline
Podiatry Arena Veteran
 
About:
Join Date: May 2006
Location: Kent
Posts: 4,290
Join Date: May 2006
Marketplace reputation 0% (0)
Thanks: 454
Thanked 912 Times in 527 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

I usually try to explain it as the heel spur being a symptom of the pain, kinda like the spots in measles. Putting ointment on the spots won't affect the measles virus. I tell them that better than half the population, were they to be x rayed, have heel spurs which do not cause any pain at all. I tell them that the PF is the actual cause of the pain and that if we just cushion the spur it won't stop the fascia pulling.

Try telling them to imagine that the PF is a piece of rope tied to an eylet hook which is screwed into their heel bone. Imagine that rope is pulling too hard and pulling the screw out of the bone. It will make the whole heel bone hurt but cushioning will not stop the screw being pulled out.

Mind you, might be as easy to do a bog standard orthotic with a 3mm ressessed bit of poron in there if the education becomes hard work!

Regards
Robert
Reply With Quote
  #5  
Old 22nd August 2007, 07:43 PM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Hi Robert,

Thanks for that, your explanation does sound quite good doesn't it? I'll give that a shot tomorrow and see if the patient understands the Robeer reasoning...

Regards

Donna
Thread Starter
Reply With Quote
  #6  
Old 22nd August 2007, 08:00 PM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,571
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 419
Thanked 2,185 Times in 1,198 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Donna:

These are common questions in most podiatry practices. Here is how I may address the patient:

"You have a condition called plantar fasciitis which may, or may not be, associated with a spur on the bottom of your heel bone. Many patients who have severe heel pain have no heel spur on their x-ray. Also, there are also many patients who have very large heel spurs on x-ray, but have never had any heel pain. Therefore, since there seems to be poor correlation between the presence or absence of a heel spur on x-ray and the amount of heel pain, we treat the patient the same whether or not they have a heel spur on x-ray."

Here is something else I may add on plantar fasciitis for patients:

"The condition of plantar fasciitis is caused generally by a pulling of the long ligament, the plantar fascia, on the bottom of the foot on the heel bone during standing, walking and running. However, since the point of attachment of the plantar fascia is on the bottom of the heel bone, then plantar fasciitis may also be caused by direct pressure from the impact forces from ground on your heel bone, just as you may have experienced by walking on a small pebble while barefoot and developing a "stone bruise". Your orthotics will be designed to both reduce the stretching of the plantar fascia and to reduce the pressure from the ground on the bottom of your heel which should give us the best chance of permanently eliminating the pain from your plantar fasciitis."

Hope this helps.
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #7  
Old 22nd August 2007, 08:43 PM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Hi Kevin,

Thanks a lot for your help... From what you and Robert have explained, I think I am definitely on the right track (despite some minor changes to the plantar fasciitis "story") with explaining the condition to the patient, and I think most people can understand that simplified explanation.

I guess there's always going to be one or two patients that can't quite grasp the concept of anatomy and foot problems... Much like your "Thought Experiments" I guess, some get it a little faster than others... I recently did an inservice with the physios at the multi-disciplinary practice that I work at, and used some of your Thought Experiments to help the physios visualise how STJ axis can affect Pronation and Supination Moments. The 2 male physios loved the diagrams and understood the concepts almost immediately, whereas the female physio took a little longer to grasp the concept...

Regards

Donna
Thread Starter
Reply With Quote
  #8  
Old 23rd August 2007, 01:33 AM
toeslayer's Avatar
toeslayer toeslayer is offline
Podiatry Arena Veteran
 
About:
Join Date: May 2007
Location: Perth WA
Posts: 1,063
Join Date: May 2007
Marketplace reputation 0% (0)
Thanks: 28
Thanked 134 Times in 102 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Donna

If they have x rays then I explain the spur may have nothing to do with the pain otherwise I describe and enthesopathy.

Cameron
Reply With Quote
  #9  
Old 23rd August 2007, 02:43 AM
Scorpio622's Avatar
Scorpio622 Scorpio622 is offline
Senior Member
 
About:
Join Date: Aug 2005
Posts: 199
Join Date: Aug 2005
Marketplace reputation 0% (0)
Thanks: 1
Thanked 13 Times in 10 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

If the patient has xrays, I will use a piece of paper or ruler aligned with the plantar calcaneus and first met head to show that the spur never contacts the ground. Most are surprised to see this because their perception (mentally and nocioceptively) is that the spur is pointing downward.

Most patients accept this demonstration and we move on......
Reply With Quote
  #10  
Old 23rd August 2007, 04:35 AM
Kevin Kirby's Avatar
Kevin Kirby Kevin Kirby is offline
Podiatry Arena Veteran
Most Valuable Poster (MVP)
 
About:
Join Date: Nov 2004
Posts: 7,571
Join Date: Nov 2004
Marketplace reputation 0% (0)
Thanks: 419
Thanked 2,185 Times in 1,198 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Quote:
Originally Posted by Donna
Hi Kevin,

Thanks a lot for your help... From what you and Robert have explained, I think I am definitely on the right track (despite some minor changes to the plantar fasciitis "story") with explaining the condition to the patient, and I think most people can understand that simplified explanation.

I guess there's always going to be one or two patients that can't quite grasp the concept of anatomy and foot problems... Much like your "Thought Experiments" I guess, some get it a little faster than others... I recently did an inservice with the physios at the multi-disciplinary practice that I work at, and used some of your Thought Experiments to help the physios visualise how STJ axis can affect Pronation and Supination Moments. The 2 male physios loved the diagrams and understood the concepts almost immediately, whereas the female physio took a little longer to grasp the concept...

Regards

Donna
However, Donna, you have demonstrated quite good ability in solving the thought experiments so the ability to think in this fashion is probably not just dependent on being male or female. After over 20 years of teaching these concepts my conclusion is that, simply, some people have it and others don't. Or as Dr. John Weed used to tell me regarding his teaching of podiatric biomechanics, 1/3rd of his students thinks he is great and very smart, another 1/3rd of his students dislike him and don't understand the material at all, and the other 1/3rd don't know what to think.
__________________
Sincerely,

Kevin

**************************************************
Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

E-mail: kevinakirby@comcast.net
Website: www.KirbyPodiatry.com

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
**************************************************
Reply With Quote
  #11  
Old 23rd August 2007, 03:24 PM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Hi Cameron and Scorpio...

Thanks for the tips... I will see how I go when I see the patient later today... She does have Xrays and will be bringing them in to show me.

And Kevin, thanks again for the kind words, the Thought Experiments are a great idea and very helpful in explaining the concepts of forces and their effects on injury. I'd love to be able to use the diagrams to explain to this patient today, but somehow I don't think she comes from a very scientific background and probably won't understand... :p

Regards

Donna :)
Thread Starter
Reply With Quote
  #12  
Old 24th August 2007, 01:17 AM
Donna's Avatar
Donna Donna is offline
Podiatry Arena Veteran
Spam Buster
 
About:
Join Date: Feb 2006
Location: Brisbane, Qld
Posts: 277
Join Date: Feb 2006
Marketplace reputation 0% (0)
Thanks: 36
Thanked 12 Times in 11 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Hi All,

OK so the patient came in today and after some more explaining - she seemed to understand - finally! Yay! So thanks to you all for your help!

However, just to make this story even more fun... today she informs me that she is subject to a 2 month waiting period on her health insurance so custom devices will have to wait until then. The countdown begins...

Regards

Donna :)
Thread Starter
Reply With Quote
  #13  
Old 24th August 2007, 01:51 AM
Nat Nat is offline
Senior Member
 
About:
Join Date: Jun 2007
Location: USA
Posts: 82
Join Date: Jun 2007
Marketplace reputation 0% (0)
Thanks: 0
Thanked 3 Times in 3 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Quote:
Originally Posted by Donna
Hi All,

OK so the patient came in today and after some more explaining - she seemed to understand - finally! Yay! So thanks to you all for your help!

However, just to make this story even more fun... today she informs me that she is subject to a 2 month waiting period on her health insurance so custom devices will have to wait until then. The countdown begins...

Regards

Donna :)
I would've just convinced her to let me give the steroid injection.
Reply With Quote
  #14  
Old 24th August 2007, 05:48 PM
Admin2's Avatar
Admin2 Admin2 is offline
Administrator
 
About:
Join Date: May 2005
Location: Cyberspace
Posts: 4,040
Join Date: May 2005
Marketplace reputation 0% (0)
Thanks: 15
Thanked 140 Times in 124 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

Other plantar fasciitis threads:
Plantar Fasciitis Discussions
Reply With Quote
  #15  
Old 13th February 2008, 11:48 PM
NewsBot's Avatar
NewsBot NewsBot is offline
The Admin that posts the news.
 
About:
Join Date: Jan 2006
Location: The Zoo, where all good monkeys should be
Posts: 14,216
Join Date: Jan 2006
Marketplace reputation 53% (0)
Thanks: 14
Thanked 607 Times in 488 Posts
Default Re: Heel Spur vs. Plantar Fasciitis: Patient Education

The Practical Application of Multimedia Technology to Facilitate the Education and Treatment of Patients With Plantar Fasciitis: A Pilot Study
Andrew Donald Beischer, Andrew Clarke, Richard Noel de Steiger, Leo Donnan, Aileen Ibuki, and Rebecca Unglik
Foot & Ankle Specialist 2008 1: 30-38.
Quote:
This study was designed to evaluate the efficacy of a multimedia patient education module when incorporated into the standard treatment protocol for patients diagnosed with plantar fasciitis. A thorough, standardized surgeon-patient education discourse took place following diagnosis. At the conclusion of the consultation, patients viewed the multimedia module. Questionnaires designed to assess understanding and satisfaction with information delivery were completed by patients following the consultation and again after viewing the module. Forty-one patients participated in the study. After viewing the module, patients achieved an average of 87% correct responses on the knowledge questionnaire, a significant improvement (P < .0001) over the 64% achieved following the surgeon-patient discourse. Ease of understanding of the information delivered by the module was rated significantly better (P < .0001) than the surgeon-patient discourse. Ninety-eight percent of patients indicated they felt well informed about plantar fasciitis following viewing the module compared with 68% following the surgeon-patient discourse. Sixty-three percent of patients indicated that the module best answered their questions, 7% preferred the surgeon, and 30% rated both equally. Multimedia plantar fasciitis educational material improved patient understanding of the standard treatment protocol and satisfaction with the information delivery in an orthopedic private practice.
Reply With Quote
Reply



Thread Tools
Display Modes

Posting Rules
You may not post new threads
You may not post replies
You may not post attachments
You may not edit your posts
vB code is On
Smilies are On
[IMG] code is On
HTML code is Off
Forum Jump

Translate This Page

Similar Threads
Thread Thread Starter Forum Replies Last Post
Is a calcaneal spur in the plantar fascia? Craig Payne General Issues and Discussion Forum 54 16th October 2014 04:50 AM
Foot Orthoses Effective in Plantar Fasciitis Treatment Kevin Kirby Biomechanics, Sports and Foot orthoses 19 29th April 2014 04:51 AM
Plantar fascia stretching exercise for plantar fasciitis NewsBot Biomechanics, Sports and Foot orthoses 16 31st March 2014 06:08 PM
Plantar Fasciitis Discussions Admin Biomechanics, Sports and Foot orthoses 55 19th March 2012 04:54 PM
Pathomechanics of plantar fasciitis Karl Landorf Biomechanics, Sports and Foot orthoses 2 21st July 2006 02:21 AM


New To Site? Need Help?

Finding your way around:

Browse the forums.

Search the site.

Browse the tags.

Search the tags.


All times are GMT -7. The time now is 05:03 AM.