| |
 |
CLINICAL PRACTICE
GUIDELINE |
|
The Diagnosis and Treatment of Heel Pain
Mechanical Posterior Heel Pain (Pathway 3)
The posterior heel is the second most common location of mechanically induced symptoms. Pathology is categorized as 1) insertional Achilles tendinitis, and 2) bursitis often associated with Haglunds deformity (pump bumps).
Insertional Achilles tendinitis most commonly presents with an insidious onset often leading to chronic posterior heel pain and swelling (6264). Pain is aggravated by increased activity (e.g., walking and/or running), and pressure caused by shoe gear. A palpable prominence may be appreciated both medially and laterally to the insertion of the Achilles tendon. Tenderness can be central or more globally located posteriorly on physical examination. Radiographic findings commonly show insertional spurring or erosion (Fig. 2).
Initial treatment centers around reducing pressure to the area (e.g., open-backed shoes), heel lifts/orthotics, NSAID therapy, and various physical therapy modalities, including stretching. Primary treatment with immobilization may be considered in particularly acute cases, although this is more commonly used if the previously described treatments are unsuccessful. Local corticosteroid injections are not recommended (65).
Resistant cases should be referred to a podiatric foot and ankle surgeon. Surgery may be indicated (e.g., resection of the posterior spur along with pathologic soft tissue inflamed bursa, diseased tendon). Various degrees of detachment with subsequent reattachment of the Achilles tendon may be needed to assure complete resection of the spur.
Bursitis associated with Haglunds deformity may occur in both sexes and at any age, although studies have shown that females aged 2030 years are most commonly affected (6669) (Fig. 3). Symptoms include acute pain and inflammation significantly aggravated by shoe gear. Pain is relieved with barefoot walking. On physical examination there is tenderness lateral to the Achilles tendon, usually associated with a palpable posterior lateral prominence. Radiographs commonly demonstrate prominence of the posterior superior surface of the calcaneus. The degree of prominence may be quantified by documenting specific radiographic angles.
Initial treatment, such as open-backed shoes, NSAID therapy, injections (with care taken not to inject the Achilles tendon), is always directed toward eliminating pressure and inflammation to the symptomatic area. Physical therapy also may be helpful.
If symptoms are not improved after an adequate period of nonoperative treatment, the patient should be referred to a podiatric foot and ankle surgeon, and surgery may be required. Resection of the prominent posterior superior aspect of the calcaneus and inflamed bursa is the indicated surgical procedure (64, 70). Although not commonly performed, calcaneal osteotomy may also be required to correct abnormal calcaneal alignment (e.g., calcaneal varus).
Neurologic Heel Pain (Pathway 4)
Neurologic heel pain is defined as pain in the heel as a result of an entrapment or irritation of one or more of the nerves which innervate this region. The nerves (Figs. 4 and 5) specifically considered are:
Posterior tibial (tarsal tunnel syndrome) Medial calcaneal (heel neuroma) Medial plantar Lateral plantar, including branch to abductor digiti minimi Sural, including lateral calcaneal
Neurologic pain in the heel or the absence of sensation in the foot and/or heel can also be due to more proximal nerve impingement syndromes (71). Patients describing pain that originates in the low back and radiates down the leg and into the foot must be assessed for radiculopathy secondary to proximal nerve root pathology.
If neurologic heel pain is suspected, appropriate referral for diagnostic studies and/or assessment by a specialist should be considered. Diagnostic studies may include:
Electromyography (EMG) Nerve conduction velocity (NCV) Magnetic resonance imaging (MRI)
After consultation reports and diagnostic studies are reviewed, accurate diagnosis and treatment protocol can be developed. In some instances, the podiatric foot and ankle surgeon will manage local conditions in the foot and ankle, while referral to appropriate specialists may be required if the pathology is found to be originating from the lumbar area.
The exact prevalence of heel pain secondary to neurologic causes in the general population is unknown (8, 11, 72, 73). Obesity, venous insufficiency, trauma, and space-occupying lesions may be factors because they can put pressure on the involved nerve (71, 74). Most causes of neurologic heel pain are unilateral. However, bilateral cases of entrapment neuropathy causing symptoms have been reported (75). In suspected neurologic heel pain, especially in bilateral presentations, an underlying systemic disease process must be ruled out.
Arthritides in Heel Pain (Pathway 4)
Most cases of heel pain encountered in clinical practice are likely to have a biomechanical etiology and respond to recommended therapy. In the process of taking a history and conducting a physical examination, a physician should consider that various systemic arthritides are also capable of presentation as heel pain. These include the seronegative arthritides, psoriatic arthritis, Reiters disease, diffuse idiopathic skeletal hyperostosis (DISH), rheumatoid arthritis, fibromyalgia, and gout (14, 31, 35, 36, 76115).
These patients may have other joint symptoms and should be questioned regarding concomitant arthralgias. This, in conjunction with careful radiographic evaluation and laboratory testing, may provide help in proper diagnosis and treatment of these unresponsive patients.
Occasionally, scintigraphy may be useful in diagnosis, as a pattern of joint involvement will be evidenced (38, 116127). Radiographs of the heel may show erosions or proliferative changes specific to one of these diseases. Rheumatologic consultation may be helpful for diagnosis and treatment.
Traumatic Heel Pain (Pathway 4)
Acute trauma to the calcaneus is the most common osseous cause of heel pain. In almost all cases, the mechanism of injury is a fall from a height onto the heel. Intra-articular fractures involving the subtalar joint result in diffuse pain in the rearfoot that is poorly localized to the heel itself. In less severe injuries, more focal symptoms are found corresponding to the anatomic area of the fracture. These include isolated injuries to the sustentaculum tali, the plantar calcaneal tubercles, and avulsion of the posterior aspect of the tuber (128135). Diagnosis is made by a history of trauma, focal pain on palpation, and radiographic confirmation of the fracture. Treatment is most often surgical when significant functional units are violated. In those cases where the fracture fragments are small, nonarticular, or minimally displaced, treatment is typically simple immobilization.
Stress fractures of the calcaneus occur as a consequence of repetitive load to the heel (122, 124, 130, 136145). The most common site of stress fracture is just posterior and inferior to the posterior facet of the subtalar joint. Although the exact mechanism is unknown, historically many patients report an antecedent increase in walking activity just prior to the onset of symptoms. The diagnosis should be entertained upon clinical suspicion and elicitation of such a history. The physical findings include tenderness to the lateral wall of the calcaneus, just posterior to the facet. There may be swelling and warmth. Pain elicited with compression of the calcaneus is highly suspicious of a stress fracture. Often the onset of symptoms precedes the radiographic findings and ancillary measures can assist in early diagnosis. Technetium bone scans are highly sensitive for stress fractures of the calcaneus in this setting. Radiographic features include an area of linear sclerosis corresponding to the fracture site. Treatment is conservative and involves protection and immobilization of the involved foot (131, 137). Progression to an acute fracture is uncommon.
Soft-tissue trauma (e.g., acute plantar fascia rupture) can also cause heel pain and be present in patients with negative radiographic and bone-scan findings (146148). Clinical examination and appropriate diagnostic imaging can lead to establishing a diagnosis and treatment plan.
Other Causes of Heel Pain (Pathway 4)
Although rare, conditions such as benign and malignant tumors, infection (soft tissue and bone), and vascular compromise must be considered as etiologies for a patients heel pain (34, 77, 149158). The potential morbidity of these conditions is substantial. Proper diagnostic testing along with consultation or referral to the appropriate specialist are paramount in these individuals. In adolescents, calcaneal apophysitis is probably the most frequent etiology of heel pain. Palliative treatment is successful in almost all cases.
2001 Clinical Practice Guideline Core Committee
James L. Thomas, DPM, Chair; Susan D. Couture, Vice Chair; David J. Caldarella, DPM, Board Liaison; Allen M. Jacobs, DPM; Michael S. Lee, DPM; Robert W. Mendicino, DPM; John M. Schuberth, DPM; and John V. Vanore, DPM.
References
1. McCarty, D. J., Gorecki, G. E. The anatomical basis of inferior calcaneal lesions. J. Am. Podiatr. Assoc. 69:527 536, 1979.
2. Bergmann, J. N. History and mechanical control of heel spur pain. Clin. Podiatr. Med. Surg. 7(2):243 259, 1990.
3. Contampasis, J. P. Surgical treatment of calcaneal spurs. J. Am. Podiatr. Assoc. 64:987 999, 1974.
4. Ferguson, H., et al. TL-61 versus Rohadur orthoses in heel spur syndrome. J. Am. Podiatr. Med. Assoc. 81(8):439 442, 1991.
5. Mitchell, I. R., et al. Deep fascia of the foot. Anatomical and clinical considerations. J. Am. Podiatr. Med. Assoc. 81(7):373 378, 1991.
6. Nack, J. D., Phillips, R. D. Shock absorption. Clin. Podiatr. Med. Surg. 7(2):391 397, 1990.
7. Root, M., et al. Normal and Abnormal Function of the Foot, vol. II, pp. 326 332, Clinical Biomechanics Corp., Los Angeles, 1977.
8. Baxter, D. E., Thigpen, C. M. Heel pain operative results. Foot Ankle 5(1):16 25, 1984.
9. Goecker, R. M., Banks, A. S. Analysis of release of the first branch of the lateral plantar nerve. J. Am. Podiatr. Med. Assoc. 90(6):281 286, 2000.
10. Heneghan, M. A., Pavlov, H. The Haglund painful heel syndrome. Experimental investigation of cause and therapeutic implications. Clin. Orthop. 187:228 234, 1984.
11. Kenzora, J. E. The painful heel syndrome: an entrapment neuropathy. Bull. Hosp. Joint Dis. Orthop. Inst. 47:178 189, 1987.
12. Przylucki, H., Jones, C. L. Entrapment neuropathy of muscle branch of lateral plantar nerve: a cause of heel pain. J. Am. Podiatr. Assoc. 71(3):119 124, 1981.
13. Shikoff, M. D., et al. A retrospective study of 195 patients with heel pain. J. Am. Podiatr. Med. Assoc. 76(2):71 75, 1986.
14. Williams, P. L. The painful heel. Br. J. Hosp.Med. 38(6):562 563, 1987.
15. Mizel, M. S., et al. Treatment of plantar fasciitis with a night splint and shoe modification consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. 17(12):732 735, 1996.
16. Ng, A. Treatment of plantar fasciitis with night splint and shoe modifications consisting of a steel shank and anterior rocker bottom. Foot Ankle Int. 18(7):458, 1997.
17. Probe, R. A., et al. Night splint treatment for plantar fasciitis. A prospective randomized study. Clin. Orthop. 368:190 195, 1999.
18. Powell, M., et al. Effective treatment of chronic plantar fasciitis with dorsiflexion night splints: a crossover prospective randomized outcome study. Foot Ankle Int. 19(1):10 18, 1998.
19. Ryan, J. Use of posterior night splints in the treatment of plantar fasciitis. Am. Fam. Physician 52(3):891 898, 901 892, 1995.
20. Wapner, K. L., Sharkey, P. F. The use of night splints for treatment of recalcitrant plantar fasciitis. Foot Ankle 12(3):135 137, 1991.
21. Woelffer, K. E., et al. Five-year follow-up results of instep plantar fasciotomy for chronic heel pain. J. Foot Ankle Surg. 39(4): 218 223, 2000.
22. Batt, M. E., et al. Plantar fasciitis: a prospective randomized clinical trial of the tension night splint. Clin. J. Sport Med. 6(3):158 162, 1996.
23. Quinn, M., Gough, A. Ultrasound guided injection of plantar fasciitis. Ann. Rheum. Dis. 57(12):749 750, 1998.
24. Miller, R. A., et al. Efficacy of first-time steroid injection for painful heel syndrome. Foot Ankle Int. 16(10):610 612, 1995.
25. Tisdel, C. L., Harper, M. C. Chronic plantar heel pain: treatment with a short leg walking cast. Foot Ankle Int. 17(1):41 42, 1996.
26. Karr, S. D. Subcalcaneal heel pain. Orthop. Clin. North. Am.
25(1):161 175, 1994.
27. Lynch, D. M., et al. Conservative treatment of plantar fasciitis. A prospective study. J. Am. Podiatr. Med. Assoc. 88(8):375 380, 1998.
28. McBryde, A. M. Plantar fasciitis. Instr. Course. Lect. 33:278 282, 1984.
29. Meltzer, E. F. A rational approach to the management of heel pain. A protocol proposal. J. Am. Podiatr. Med. Assoc. 79(2):89 92, 1989.
30. Quaschnick, M. S. The diagnosis and management of plantar fasciitis. Nurse Pract. 21(4):50 54, 6053, quiz 64 55, 1996.
31. Olivieri, I., et al. Enthesiopathy: clinical manifestations, imaging and treatment. Baillieres Clin. Rheumatol. 12(4):665 681, 1998.
32. Ott, H., Van Linthoudt, D. Heel pain in sarcoidosis is sarcoid a cause of spondarthropathy? Br. J. Rheumatol. 26(6):468, 1987.
33. Pavlica, L., et al. [Reiters syndrome analysis of 187 patients]. Vojnosanit. Pregl. 54(5):437 446, 1997.
34. Perrot, S., et al. Monostotic Pagets disease involving the calcaneus. Diagnostic and therapeutic problems. Two case-reports. Rev. Rhum. Engl. Ed. 62(1):45 47, 1995.
35. Resnick, D., et al. Calcaneal abnormalities in articular disorders. Rheumatoid arthritis, ankylosing spondylitis, psoriatic arthritis and Reiters syndrome. Radiology 125:355 366, 1977.
36. Resnick, D., Niwayama, G. Rheumatoid arthritis and the seronegative spondyloarthropathies: radiographic and pathologic changes. In Diagnosis of Bone and Joint Disorders, pp. 1104 1110, edited by D. Resnick, W. B. Saunders, Philadelphia, 1995.
37. Shaw, R. A., et al. Heel pain in sarcoidosis. Ann. Intern. Med. 109(8):675 677, 1988.
38. Lafforgue, P., et al. An unexpected, benign cause of increased muscular uptake at bone scintigraphy. Clin. Exp. Rheumatol. 12(3):309 311, 1994.
39. Lester, D. K., Buchanan, J. R. Surgical treatment of plantar fasciitis. Clin. Orthop. 186:202 204, 1984.
40. Lewis, G., et al. The plantar approach to heel surgery: a retrospective study. J. Foot. Surg. 30(6):542 546, 1991.
41. OMalley, M. J., et al. Endoscopic plantar fasciotomy for chronic heel pain. Foot Ankle Int. 21(6):505 510, 2000.
42. Ogilvie-Harris, D. J., Lobo, J. Endoscopic plantar fascia release. Arthroscopy 16(3):290 298, 2000.
43. Perelman, G. K., et al. The medial instep plantar fasciotomy. J Foot Ankle Surg. 34(5):447 457; discussion 509 410, 1995.
44. Snider, M. P., et al. Plantar fascia release for chronic plantar fasciitis in runners. Am. J. Sports. Med. 11(4):215 219, 1983.
45. Stone, P. A., Davies, J. L. Retrospective review of endoscopic plantar fasciotomy 1992 through 1994. J. Am. Podiatr. Med. Assoc. 86(9):414 420, 1996.
46. Stone, P. A., McClure, L. P. Retrospective review of endoscopic plantar fasciotomy: 1994 through 1997. J. Am. Podiatr. Med. Assoc. 89(2):89 93, 1999.
47. Tountas, A. A., Fornasier, V. L. Operative treatment of subcalcaneal pain. Clin. Orthop. 332:170 178, 1996.
48. Vohra, P. K., et al. Long-term follow-up of heel spur surgery. A 10-year retrospective study. J. Am. Podiatr. Med. Assoc. 89(2):81 88, 1999.
49. Ward, W. G., Clippinger, F. W. Proximal medial longitudinal arch incision for plantar fascia release. Foot Ankle 8(3):152 155, 1987.
50. White, D. L. Plantar fascial release. J. Am. Podiatr. Med. Assoc. 84(12):607 613, 1994.
51. Benton-Weil, W., et al. Percutaneous plantar fasciotomy: a minimally invasive procedure for recalcitrant plantar fasciitis. J. Foot Ankle Surg. 37(4):269 272, 1998.
52. Barrett, S. L. Endoscopic plantar fasciotomy. Clin. Podiatr. Med. Surg. 11(3):469 481, 1994.
53. Barrett, S. L., Day, S. V. Endoscopic plantar fasciotomy: two portal endoscopic surgical techniques clinical results of 65 procedures. J. Foot Ankle Surg. 32(3):248 256, 1993.
54. Krischek, O., et al. [Symptomatic low-energy shockwave therapy in heel pain and radiologically detected plantar heel spur]. Z. Orthop. Ihre. Grenzgeb. 136(2):169 174, 1998.
55. Maier, M., et al. Extracorporeal shock wave application for chronic plantar fasciitis associated with heel spurs: prediction of outcome by magnetic resonance imaging. J. Rheumatol. 27(10):2455 2462, 2000.
56. Perlick, L., et al. [High energy shock wave treatment of the painful heel spur]. Unfallchirurg. 101(12):914 918, 1998.
57. Sistermann, R., Katthagen, B. D. [5-years lithotripsy of plantar of plantar heel spur: experiences and results a follow-up study after 36.9 months]. Z. Orthop. Ihre. Grenzgeb. 136(5):402 406, 1998.
58. Wang, C. J., et al. Treatment of painful heels using extracorporeal shock wave. J. Formos. Med. Assoc. 99(7):580 583, 2000.
59. Wander, D. S. Endoscopic plantar fasciotomy versus traditional heel spur surgery. J. Foot Ankle Surg. 33(3):322, 1994.
60. Tomczak, R. L., Haverstock, B. D. A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J. Foot Ankle Surg. 34(3):305 311, 1995.
61. Wander, D. S. A retrospective comparison of endoscopic plantar fasciotomy to open plantar fasciotomy with heel spur resection for chronic plantar fasciitis/heel spur syndrome. J. Foot Ankle Surg. 35(2):183 184, 1996.
62. Clement, D. B., et al. Achilles tendinitis and peritendinitis: etiology and treatment. Am. J. Sports Med. 12(3):179 184, 1984.
63. Nelen, G., et al. Surgical treatment of chronic Achilles tendinitis. Am. J. Sports Med. 17(6):754 759, 1989.
64. Stephens, M. M. Haglunds deformity and retrocalcaneal bursitis. Orthop. Clin. North Am. 25(1):41 46, 1994.
65. Ford, L. T., DeBender, J. Tendon rupture after local steroid injection. South Med. J. 72:827 830, 1979.
66. Ruch, J. A. Haglunds disease. J. Am. Podiatr. Assoc. 64:1000 1003, 1974.
67. Vega, M. R., et al. Haglunds deformity. J. Am. Podiatr. Assoc. 74:129 135, 1984.
68. Le, T. A., Joseph, P. M. Common exostectomies of the rearfoot. Clin. Podiatr. Med. Surg. 8(3):611 617, 1981.
69. Pavlov, H., et al. The Haglund syndrome: initial and differential diagnosis. Radiology 144(1):83 88, 1982.
70. Sammarco, G. J., Taylor, A. L. Operative management of Haglunds deformity in the nonathlete: a retrospective study. Foot Ankle Int. 19(11):724 729, 1998.
71. Schon, L. C., et al. Heel pain syndrome: electrodiagnostic support for nerve entrapment. Foot Ankle 14(3):129 135, 1993.
72. Murphy, P.C., Baxter, D. E. Nerve entrapment of the foot and ankle in runners. Clin. Sports Med. 4(4):753 763, 1985.
73. Henricson, A.S., Westlin, N. E. Chronic calcaneal pain in athletes: entrapment of the calcaneal nerve? Am. J. Sports Med. 12(2):152 154, 1984.
74. MacFarlane, I. J. A., DuToit, S. N. A ganglion causing tarsal tunnel syndrome. S. Afr. Med. J. 48:256 260, 1974.
75. Goodman, C. R., Kehr, L. E. Bilateral tarsal tunnel syndrome. J. Am. Podiatr. Assoc. 73:256 260, 1983.
76. Resnick, R. B., et al. Analysis of the heel pad fat in rheumatoid arthritis. Foot Ankle Int. 20(8):481 484, 1999.
77. Jones, R. O., et al. Rheumatoid nodules affecting both heels with surgical debulking: a case report. J. Am. Podiatr. Med. Assoc. 86(4):179 182, 1996.
78. Jahss, M. H. Foot and ankle pain resulting from rheumatic conditions. Curr. Opin. Rheumatol. 4(2):233 240, 1992.
79. Bouysset, M., et al. [Heel involvement in rheumatoid polyarthritis]. Rev. Rhum. Mal. Osteoartic. 57(11):799 803, 1990.
80. Lichniak, J. E. The heel in systemic disease. Clin. Podiatr. Med. Surg. 7(2):225 241, 1990.
81. Bouysset, M., et al. The rheumatoid heel: its relationship to other disorders in the rheumatoid foot. Clin. Rheumatol. 8(2):208 214, 1989.
82. Dimonte, P., Light, H. Pathomechanics, gait deviations, and treatment of the rheumatoid foot: a clinical report. Phys. Ther. 62(8):1148 1156, 1982.
83. Gerster, J. C., et al. The painful heel. Comparative study in rheumatoid arthritis, ankylosing spondylitis, Reiters syndrome, and generalized osteoarthrosis. Ann. Rheum. Dis. 36(4):343 348, 1977.
84. Raymakers, R. The painful foot. Practitioner 215(1285):61 68, 1975.
85. Furey, J. G. Plantar fasciitis. The painful heel syndrome. J. Bone Joint Surg. 57-A(5):672 673, 1975.
86. Vidigal, E., et al. The foot in chronic rheumatoid arthritis. Ann. Rheum. Dis. 34(4):292 297, 1975.
87. Gerster, J. C. Plantar fasciitis and Achilles tendinitis among 150 cases of seronegative spondarthritis. Rheumatol. Rehabil. 19(4): 218 222, 1980.
88. Lipscomb, P. R. Surgery of the rheumatoid foot: preferable procedures. Rev. Chir. Orthop. 67(3):375 382, 1981.
89. Riel, K. A., Bernett, P. [Therapy-resistant heel pain an indication for surgery in sports traumatology]. Sportverletz. Sportschaden. 4(3):121 124, 1990.
90. Forestier, J., Lagier, R. Ankylosing hyperostoses of the spine. Clin. Orthop. 74:65 83, 1971.
91. Lehman, T. J. Enthesitis, arthritis, and heel pain. J. Am. Podiatr. Med. Assoc. 89(1):18 19, 1999.
92. Leirisalo-Repo, M. Prognosis, course of disease, and treatment of the spondyloarthropathies. Rheum. Dis. Clin. North Am.
24(4):737 751, viii, 1998.
93. Salvarani, C., et al. Isolated peripheral enthesitis and/or dactylitis: a subset of psoriatic arthritis. J. Rheumatol. 24(6):1106 1110, 1997.
94. Gadzhinova, L. D., et al. [The local therapy of enthesitis and bursitis of the calcaneal area in seronegative spondylarthritis]. Ter. Arkh. 69(5):47 49, 1997.
95. Scherer, P. R., et al. Misdiagnosed recalcitrant heel pain associated with HLA-B27 antigen. J. Am. Podiatr. Med. Assoc. 85(10):538 542, 1995.
96. Deesomchok, U., Tumrasvin, T. Clinical comparison of patients with ankylosing spondylitis, Reiters syndrome and psoriatic arthritis. J. Med. Assoc. Thai. 76(2):61 70, 1993.
97. Dougados, M., et al. The European Spondylarthropathy Study Group preliminary criteria for the classification of spondylarthropathy. Arthritis Rheum. 34(10):1218 1227, 1991.
98. Khan, M. A., van der Linden, S. M. A wider spectrum of spondyloarthropathies. Semin. Arthritis Rheum. 20(2):107 113, 1990.
99. Turlik, M. A. Seronegative arthritis as a cause of heel pain. Clin. Podiatr. Med. Surg. 7(2):369 375, 1990.
100. Lopez Longo, F. J., et al. [Reiters syndrome: considerations on the frequency and mid-term course of its juvenile form]. An. Esp. Pediatr. 29(4):298 301, 1988.
101. Job-Deslandre, C., et al. [Ankylosing spondylitis with juvenile onset. Study of 62 cases]. Rev. Rhum. Mal. Osteoartic. 54(3): 209 212, 1987.
102. Doury, P., et al. [Clinical aspects of reactive arthritis caused by Chlamydia]. Rev. Rhum. Mal. Osteoartic. 50(11):753 757, 1983.
103. Hochberg, M. C., et al. The absence of back pain in classical ankylosing spondylitis. Johns Hopkins Med. J. 143(6):181 183, 1978.
104. Hidle, I. [Heel pain as a symptom in rheumatic diseases]. Tidsskr. Nor. Laegeforen. 96(8):504 505, 1976.
105. Resnick, D., Niwayama, G. Ankylosing spondylitis, In Diagnosis of Bone and Joint Disorders, pp. 1047 1053, edited by D. Resnick, W. B. Saunders, Philadelphia, 1995.
106. Resnick, D., Psoriatic arthritis. In Diagnosis of Bone and Joint Disorders, pp. 1082 1086, edited by D. Resnick, W. B. Saunders, Philadelphia, 1995.
107. Mata, S., et al. A controlled study of diffuse idiopathic skeletal hyperostosis. Clinical features and functional status. Medicine (Baltimore) 76(2):104 117, 1997.
108. Harvey, C. K. Fibromyalgia. Part II. Prevalence in the podiatric patient population. J. Am. Podiatr. Med. Assoc. 83(7):416 417, 1993.
109. Calmels, C., et al. [Involvement of the foot in reactive arthritis. A retrospective study of 105 cases]. Rev. Rhum. Ed. Fr. 60(5): 324 329, 1993.
110. Scutellari, P. N., et al. [Diffuse idiopathic skeletal hyperostosis. Review of diagnostic criteria and analysis of 915 cases]. Radiol. Med. (Torino) 83(6):729 736, 1992.
111. Kung, E. E., Glauser, T. [Ulcerating gout tophi. Surgical therapy in a patient with hyperuricemia, hyperlipidemia and alcohol abuse]. Hautarzt 42(7):461 463, 1991.
112. Resnick, D., Niwayama, G. Gouty arthritis. In Diagnosis of Bone and Joint Disorders, pp. 1511 1551, edited by D. Resnick, W. B. Saunders, Philadelphia, 1995.
113. Resnick, D. Diffuse idiopathic skeletal hyperostoses (DISH). In Diagnosis of Bone and Joint Disorders, pp. 1471 1475, edited by, D. Resnick, W. B. Saunders, Philadelphia, 1995.
114. Malhotra, C. M., et al. Ossification of the plantar fascia and peroneus longus tendons in a diffuse skeletal hyperostosis (DISH). J. Rheumatol. 13:215 218, 1986.
115. Garber, E. K., Silver, S. Pedal manifestations of DISH. Foot Ankle 3:12 16, 1982.
116. Yozsa, S., et al. Imaging of the rearfoot. J. Am. Podiatr. Med. Assoc. 89(6):292 301, 1999.
117. Lokiec, F.,Wientroub, S. Calcaneal osteochondritis: a new overuse injury. J. Pediatr. Orthop. B 7(3):243 245, 1998.
118. ODuffy, E. K., et al. Foot pain: specific indications for scintigraphy. Br. J. Rheumatol. 37(4):442 447, 1998.
119. Tudor, G. R., et al. The role of bone scintigraphy and plain radiography in intractable plantar fasciitis. Nucl. Med. Commun. 18(9):853 856, 1997.
120. Dasgupta, B., Bowles, J. Scintigraphic localisation of steroid injection site in plantar fasciitis. Lancet 346(8987):1400 1401, 1995.
121. Lin, W. Y., et al. Bone scintigraphy in evaluation of heel pain in Reiters disease: compared with radiography and clinical examination. Scand. J. Rheumatol. 24(1):18 21, 1995.
122. Smith, S. D., et al. Fatigue perturbation of the os calcis. J. Foot Ankle Surg. 33(4):402 410, 1994.
123. Intenzo, C. M., et al. Evaluation of plantar fasciitis by three-phase bone scintigraphy. Clin. Nucl. Med. 16(5):325 328, 1991.
124. Nussbaum, A. R., et al. Bone stress lesions in ballet dancers: scintigraphic assessment. AJR 150(4):851 855, 1988.
125. Williams, P. L., et al. Imaging study of the painful heel syndrome. Foot Ankle 7(6):345 349, 1987.
126. Vasavada, P. J., et al. Plantar fascitis early blood pool images in diagnosis of inflammatory process. Foot Ankle 5(2):74 76, 1984.
127. Graham, C. E. Painful heel syndrome: rationale of diagnosis and treatment. Foot Ankle 3(5):261 267, 1983.
128. Omey, M. L., Micheli, L. J. Foot and ankle problems in the young athlete. Med. Sci. Sports Exerc. 31(7 Suppl):S470 S486, 1999.
129. Bencardino, J., et al. MR imaging in sports injuries of the foot and ankle. Magn. Reson. Imaging Clin. North Am. 7(1):131 149, ix, 1999.
130. Matheson, G. O., et al. Musculoskeletal injuries associated with physical activity in older adults. Med. Sci. Sports Exerc. 21(4): 379 385, 1989.
131. Schuberth, J. M. Calcaneal fractures. In Trauma of the Foot and Ankle, pp. 535 574, edited by B. Scurran, Churchill-Livingstone, New York, 1996.
132. Carey, E. J., et al. Extra-articular fractures of the calcaneus. J. Trauma. 5:363 365, 1965.
133. Lungstadaas, S. Treatment of avulsion fractures of the tuber calcanei. Acta Chir. Scand. 137:579, 1971.
134. Lowy, M. Avulsion fractures of the calcaneus. J. Bone Joint Surg. 51-B:494 497, 1969.
135. Miller, W. E., Lichtblau, P. O. The smashed heel. South. Med. J. 58(10):1229 1237, 1965.
136. Worthen, B. M., Yanklowitz, B. The pathophysiology and treatment of stress fractures in military personnel. J. Am. Podiatr. Assoc. 68:317 325, 1978.
137. Greany, R. B., et al. Distribution and natural history of stress fractures in US marine recruits. Radiology 146:339 346, 1985.
138. Schuberth, J. M. Calcaneal stress fractures: a pathomechanical etiology. In Reconstructive surgery of the Foot and Leg: Update 98, pp. 81 87, The Podiatry Institute, Tucker, GA, 1998.
139. Tanz, S. S. Heel pain. Clin. Orthop. 28:169 178, 1963.
140. Hoffman, S. J., Thul, J. R. Fractures of the calcaneus secondary to heel spur surgery: An analysis and case report. J. Am. Podiatr. Med. Assoc. 75(5):267 271, 1985.
141. Bordelon, R. L. Subcalcaneal pain: present status, evaluation, and management. Instr. Course Lect. 33:283 287, 1984.
142. Zeiss, J., et al. Magnetic resonance imaging of the calcaneus: normal anatomy and application in calcaneal fractures. Foot Ankle 11(5):264 273, 1991.
143. Coughlin, R. R. Common injuries of the foot. Often more thanjust a sprain. Postgrad. Med. 86(3):175 179, 182, 185, 1989.
144. Silver, D. A., et al. Fractures of the calcaneum. J. Bone Joint Surg. Br. 75-B(5):838, 1993.
145. Manoli, A., et al. Calcaneal fracture after cortical bone removal. Foot Ankle 13(9):523 525, 1992.
146. Ahstrom, J. P. Spontaneous rupture of the plantar fascia. Am. J. Sports Med. 16(3):306 307, 1988.
147. Pai, V. S. Rupture of the plantar fascia. J. Foot Ankle Surg. 35(1):39 40, 1996.
148. Theodorou, D. J., et al. Plantar fasciitis and fascial rupture: MR imaging findings in 26 patients supplemented with anatomic data in cadavers. Radiographics 20:S181 197, 2000.
149. Kaminsky, S. L., et al. Myositis ossificans: pedal manifestations. J. Foot Surg. 31(2):173 181, 1992.
150. Berlin, S. J., et al. Tumors of the heel. Clin. Podiatr. Med. Surg. 7(2):307 321, 1990.
151. Freedman, D. M., Henderson, R. C. Metastatic breast carcinoma to the os calcis presenting as heel pain. South. Med. J. 88(2): 232 234, 1995.
152. Gisserot, O., et al. Heel pain as the inaugural manifestation of metastatic prostate cancer. Rev. Rhum. Engl. Ed. 63(11):870 871, 1996.
153. Groves, M. J., Stiles, R. G. Metastatic breast cancer presenting as heel pain. J. Am. Podiatr. Med. Assoc. 88(8):400 405, 1998.
154. Harman, R. R., Matthews, C. N. Painful piezogenic pedal papules. Br. J. Dermatol. 90(5):573 574, 1974.
155. Kosinski, M., Lilja, E. Infectious causes of heel pain. J. Am. Podiatr. Med. Assoc. 89(1):20 23, 1999.
156. Llauger, J., et al. MR imaging of benign soft-tissue masses of the foot and ankle. Radiographics 18(6):1481 1498, 1998.
157. Nierenberg, G., et al. Pseudoaneurysm with an arteriovenous fistula of the tibial vessels after plantar fasciotomy: a case report. Foot Ankle Int. 18(8):524 525, 1997.
158. Schlappner, O. L., et al. Painful and nonpainful piezogenic pedal papules. Arch. Dermatol. 106(5):729 733, 1972.
|
