New York State Medical Treatment Guidelines

for Plantar Heel Pain in workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Plantar Heel Pain.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Plantar Heel Pain (“Plantar Fasciitis”)

The most typical location of foot pain is the heel. “Plantar fasciitis,” also known as plantar heel pain, is widespread. Runner’s heel, painful heel syndrome, heel spur syndrome, subcalcaneal pain, calcaneodynia, plantar fasciopathy, and calcaneal periostitis are additional names for plantar heel pain.

Typically, plantar fasciitis causes severe discomfort in the medial or middle heel’s inferior or plantar portion. Distal pain toward the arch of the foot may be experienced. As previously mentioned, it is most obvious when carrying out weight-bearing activities, particularly the first step of the day or just after periods of sitting or recumbency.

More than 90% of individuals with plantar fasciitis experience resolution with non-surgical treatment within six to twelve months. Plantar fasciitis often responds well to conservative care.

Plantar heel pain is initially treated non-invasively. Over a six to twelve month period, non-invasive treatments will successfully treat more than 90% of cases of plantar heel pain. Reassuring the patient that 95% of persons with plantar fasciitis would have symptom relief in 12 to 18 months may be the most crucial non-operative treatment.

Diagnostic Studies for Plantar Heel Pain in workers compensation patients

  1. Use of X-Ray for Diagnosis of Plantar Heel Pain

    Use of X-Ray for Diagnosis of Plantar Heel Pain is recommended for determining the cause of patients’ probable fractures who have plantar heel pain.

    Indication: Evaluation of plantar heel pain to rule out other causes of heel pain or to rule out calcaneal fracture or osseous tumours. It is not recommended to obtain plain videos alone to look for heel spurs.

     

  2. MRI for Diagnosis of Select Patients with Plantar Fasciitis

    MRI for Diagnosis of Select Patients with Plantar Fasciitis is recommended for the assessment of specific plantar fasciitis patients.

    Indications: If the discomfort in the heel does not go away, it is possible that the plantar fascia has ruptured, the talar dome has become avascular, or the talar neck has undergone stress fracture.

    Rationale for Recommendation: In addition to plantar fasciitis, calcaneal stress fractures, plantar fascia ruptures, perifascial fluid, and calcaneal spurs are other causes of heel discomfort that may be diagnosed using an MRI. ganglion cyst, joint fluid, avascular necrosis of the talar dome, and stress Osteoid tumours and talar neck fracture.

     

  3. SPECT-CT for Diagnosis of Plantar Fasciitis

    SPECT-CT for Diagnosis of Plantar Fasciitis is not recommended for the diagnosis of plantar heel pain.

     

  4. Ultrasound for Diagnosis of Plantar Fasciitis

    Ultrasound for Diagnosis of Plantar Fasciitis is recommended for the assessment of specific plantar fasciitis sufferers.

    Indications: When a clinical diagnosis is ambiguous or there has been no improvement following a four to six-week course of conservative treatment, plantar heel pain should be evaluated.

    Rationale for Recommendation: is recommended for cases of suspected plantar fascia rupture or plantar calcaneal bursitis if symptoms are not resolved after a trial of non-invasive therapy.

Medications for Plantar Heel Pain

Ibuprofen, naproxen, or other NSAIDs from an earlier generation are suggested as first-line treatments for the majority of patients. For patients who are not candidates for NSAIDs, acetaminophen (or the analogue paracetamol) may be a viable alternative, even if the majority of research indicates it is just marginally less effective than NSAIDs.

There is proof that NSAIDs are less dangerous and just as effective in treating pain as opioids, such as tramadol.

  1. Non-steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative

    Non-steroidal Anti-inflammatory Drugs (NSAIDs) NSAIDs for Treatment of Acute, Subacute, Chronic, or Postoperative are recommended for the treatment of severe, mild, chronic, or pain from plantar fasciitis after surgery.

    Indications: NSAIDs are advised as a treatment for plantar fasciitis pain that is acute, subacute, chronic, or postoperative. First, try over-the-counter (OTC) medications to see whether they work.

    Frequency/Duration: Many Patients may find it reasonable to use as needed.

    Indications for Discontinuation: Foot or ankle discomfort that has gone away, ineffectiveness, or the emergence of side symptoms that need discontinuation.

     

  2. NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding

    NSAIDs for Patients at High-Risk of Gastrointestinal Bleeding are recommended Misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors are used concurrently by individuals who are at high risk of gastrointestinal bleeding.

    Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a prolonged course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

    Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

    Indications for Discontinuation: Intolerance, the emergence of unfavourable effects, or withdrawal of NSAID.

     

  3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

    NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended Acetaminophen or aspirin as the first-line therapy appears to be the safest considering cardiovascular effects. If necessary, non-selective NSAIDs are recommended to COX-2-specific medications.

    To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in individuals receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

     

  4. Acetaminophen for Treatment

    Acetaminophen for Treatment is recommended for the treatment of acute, subacute, or chronic plantar fasciitis pain, especially in people who have medical conditions that make NSAIDs contraindicated.

    Indications: Acute, subacute, chronic, and postoperative patients with foot/ankle pain.

    Dose/Frequency: Depending on the manufacturer’s guidelines; applicable on a need-to-know basis. Hepatic toxicity is demonstrated when greater than 4 g/day.

    Indications for Discontinuation: Resolution of pain, adverse effects or Intolerance.

     

  5. Infliximab for Acute, Subacute, or Chronic Plantar Fasciitis

    Infliximab for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended for the treatment of acute, subacute, or chronic plantar fasciitis.

     

  6. Opioids for Acute, Subacute, or Chronic Plantar Fasciitis Pain

    Opioids for Acute, Subacute, or Chronic Plantar Fasciitis Pain are not recommended to treat acute, subacute, or chronic condition fasciitis of the foot.

     

  7. Opioids for Post Op Plantar Fasciitis

    Opioids for Post Op Plantar Fasciitis is recommended for brief use in the days following surgery (not to for a subset of patients with plantar fasciitis (no more than seven).

    Indications: control of postoperative pain.

    Frequency/Dose/DurationFollow the manufacturer’s recommendations for frequency and dosage; can be taken on time or as needed. Usually advised to be taken for brief courses (a few days), followed by tapering to nighttime use if necessary, and then discontinued.

    Indications for Discontinuation: frequency and dosage as directed by the manufacturer recommendations; may be acted upon when necessary or as planned. Generally suggested to be taken for short courses (a few days), with subsequent

    If necessary, tapering to nighttime use followed by discontinuation.

    Rationale for Recommendations: No reliable evidence exists to support the use of opioids to treat acute, subacute, or persistent plantar

    heel ache. Most patients with plantar fasciitis typically do not not have pain sufficient to merit trialling with the dangers of opioids. They

    are not suggested for routine use.

    Since some patients may not have enough pain relief from NSAIDs, it may be beneficial to utilise opioids sparingly in the immediate postoperative period, especially at night. Opioids are advised for brief, selective use in postoperative patients, with nighttime usage being the preferred method for achieving postoperative sleep that doesn’t interfere with early rehabilitation.

     

  8. Oral or Intramuscular Glucocorticosteroids for Acute, Subacute, or Chronic Plantar Heel Pain

    Oral or Intramuscular Glucocorticosteroids for Acute, Subacute, or Chronic Plantar Heel Pain are not recommended to treat acute, subacute, or chronic conditions heel plantar discomfort.

    Rationale for RecommendationThe use of glucocorticosteroids via oral or intramuscular routes is not advised because there is insufficient evidence to support their use, but there is evidence of their efficacy for a number of other treatments.

     

  9. Lidocaine Patches for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis

    Lidocaine Patches for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis are not recommended to treat postoperative, chronic, subacute, or acute plantar fasciitis.

    Lidocaine Patch Use for Plantar Fasciitis: Evidence

     

  10. Topical NSAIDs for Acute, Subacute, or Chronic Plantar Fasciitis Pain

    Topical NSAIDs for Acute, Subacute, or Chronic Plantar Fasciitis Pain are recommended for treatment of acute, subacute, or chronic plantar fascial pain syndromes.

    Indications:mild, moderate, or severe plantar fasciitis, as well as in patients who cannot receive oral medication. There is no proof that one topical NSAID is preferable to another in comparison

    Frequency/Duration: frequency in accordance with the manufacturer’s advice. NSAIDs used topically have been applied for one to three weeks.

    Indications for Discontinuation:Resolution, intolerance, unfavourable outcomes, or a lack of advantages.

    Rationale for RecommendationThey are advised for the treatment of acute, subacute, and chronic plantar fasciitis or plantar heel pain, especially in those who are unsuitable for or do not tolerate oral medication.

     

  11. Topical NSAIDs for Postoperative Plantar Fasciitis

    Topical NSAIDs for Postoperative Plantar Fasciitis are not recommended treating plantar fasciitis following surgery.

Treatments for Plantar Heel Pain

  1. Cryotherapy for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain

    Cryotherapy for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain are recommended for the management of surgical, chronic, or subacute plantar heel pain.

    Frequency/Duration: Approximately three to five self applications per day as needed.

    Indications for Discontinuation: Resolution, adverse effects, noncompliance.

     

  2. Heat Therapy for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain

    Heat Therapy for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain are recommended for treatment of acute, subacute, chronic, or postoperative plantar heel pain.

    Indications: All patients with plantar heel pain.

    Frequency/Duration: Approximately three to five self applications per day as needed.

    Indications for Discontinuation: Resolution, adverse effects, noncompliance.

    Rationale for Recommendations: Ice and heat may help particularly with more acute symptoms.

Mobilization / Immobilization for Plantar Heel Pain

  1. Casting for Chronic Plantar Fasciitis

    Casting for Chronic Plantar Fasciitis is not recommended as a cure for persistent plantar fasciitis.

     

  2. Night Splints for Plantar Heel Pain

    Night Splints for Plantar Heel Pain is recommended for persistent or subacute plantar heel discomfort. Subacute or chronic plantar fasciitis needs brief relief from pain and stiffness.

    Frequency/Duration: Every night for as long as it’s successful (as measured by improvement in symptoms and function while receiving medical attention).

    Indications for Discontinuation: Efficacy, side effects, intolerance, and disobedience.

Rehabilitation for Plantar Heel Pain

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put in an internal effort to finish a particular activity or assignment. The procedures known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their side.

Passive therapies are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Active interventions should be emphasised above passive \sInterventions.

As an extension of the healing process, the patient should be advised to continue both active and passive therapy at home. keep up the improvements. One further step that can be taken is using assistive technology. included into the treatment strategy to promote functional improvements.

  1. Magnets for Acute, Subacute or Chronic Plantar Heel Pain

    Magnets for Acute, Subacute or Chronic Plantar Heel Pain is not recommended for the relief of sudden, gradual, or persistent plantar heel discomfort.

     

  2. Stretching Exercises for Plantar Fasciitis

    Stretching Exercises for Plantar Fasciitis is recommended in order to treat plantar fasciitis.

    Indications: either chronic, subacute, or acute plantar fasciitis.

    Frequency/Duration: No time limit has been set; three ten-minute sessions per day.

    Indications for Discontinuation: Efficacy, side effects, intolerance, and disobedience.

     

  3. Heel Taping for Acute or Subacute Plantar Fasciitis or Heel Pain

    Heel Taping for Acute or Subacute Plantar Fasciitis or Heel Pain is recommended as a quick fix for heel discomfort or subacute or acute plantar fasciitis.

    Indications: Patients with acute or subacute plantar fasciitis who do not have adhesive allergies as a temporary pain-relieving measure.

    Frequency/Duration: applying tape every day for one to four weeks.

    Indications for Discontinuation: resolution, negative consequences, failure to comply, finishing a four-week course in Treatment.

     

  4. Heel Taping for Chronic Plantar Fasciitis or Heel Pain

    Heel Taping for Chronic Plantar Fasciitis or Heel Pain are recommended in order to treat persistent plantar heel discomfort or fasciitis.

    Rationale for Recommendations: The effectiveness of taping only provides minimal short-term pain relief. Taping typically short-term use only due to the risk of skin irritation. degradation and sensitization. Utilising tape is advised as a temporary measure to use in conjunction with alternative non-surgical therapies

     

  5. Acupuncture for Acute, Subacute, or Chronic Plantar Fasciitis

    Acupuncture for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended treatment for immediate, short-term, or plantar fasciitis that persists.

     

  6. Low Frequency Electrical Stimulation for Acute, Subacute, or Chronic Plantar Fasciitis

    Low Frequency Electrical Stimulation for Acute, Subacute, or Chronic Plantar Fasciitis is not recommended for plantar fasciitis that is acute, subacute, or chronic.

     

  7. Extracorporeal Shockwave Therapy for Chronic Plantar Fasciitis

    Extracorporeal Shockwave Therapy for Chronic Plantar Fasciitis is recommended for recalcitrant chronic diseases in a few people with chronic plantar fasciitis.

    Indications: Chronic plantar heel pain consistent with plantar fasciitis. Patients frequently had at least six months of discomfort and have failed treatment with active and passive exercise, NSAIDs, and glucocorticosteroid injection in most studies of ESWT used to treat plantar fasciitis (s). The choice to employ ESWT is unaffected by the existence or absence of a heel spur.

    Frequency/Duration: There are many therapy procedures; one to three sessions may be appropriate and have been reported to be effective.

    Indications for Discontinuation: Dispute, Tolerance, and Noncompliance

     

  8. Extracorporeal Shockwave Therapy for Acute or Subacute Plantar Fasciitis

    Extracorporeal Shockwave Therapy for Acute or Subacute Plantar Fasciitis are not recommended in order to treat foot fasciitis that is either acute or subacute.

     

  9. Ultrasound or Fluoroscopy Guidance for Shockwave Therapy for Plantar Fasciitis

    Ultrasound or Fluoroscopy Guidance for Shockwave Therapy for Plantar Fasciitis is not recommended in order to treat plantar fasciitis.

     

  10. Local Anesthesia with High Shockwave Therapy for Plantar Fasciitis

    Local Anesthesia with High Shockwave Therapy for Plantar Fasciitis is recommended for the treatment of plantar fasciitis in conjunction with high-energy ESWT.

     

  11. Local Anesthesia with Low or Medium Shockwave Therapy for Plantar Fasciitis

    Local Anesthesia with Low or Medium Shockwave Therapy for Plantar Fasciitis is not recommended for the treatment of plantar fasciitis.

     

  12. Radial Extracorporeal Shockwave Therapy for Chronic Plantar Fasciitis

    Radial Extracorporeal Shockwave Therapy for Chronic Plantar Fasciitis is not recommended for the treatment of chronic plantar fasciitis.

     

  13. Radial Extracorporeal Shockwave Therapy for Acute or Subacute Plantar Fasciitis

    Radial Extracorporeal Shockwave Therapy for Acute or Subacute Plantar Fasciitis is not recommended for the treatment of acute or subacute plantar fasciitis.

     

  14. Iontophoresis with Glucocorticosteroid or Acetic Acid for Acute, Subacute, or Chronic Plantar Fasciitis

    Iontophoresis with Glucocorticosteroid or Acetic Acid for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended for the treatment of those who have either chronic, subacute, or acute plantar fasciitis.

     

  15. Low-level Laser Therapy for Acute, Subacute, or Chronic Plantar Fasciitis

    Low-level Laser Therapy for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended for the treatment of either chronic or subacute plantar fasciitis.

     

  16. Manipulation for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain

    Manipulation for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain are not recommended for the management of postoperative, chronic, or subacute plantar heel pain.

     

  17. Massage and Soft Tissue Mobilisation for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis

    Massage and Soft Tissue Mobilisation for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis are not recommended – for the treatment of postoperative, chronic, subacute, or acute plantar fasciitis.

     

  18. Phonophoresis for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain

    Phonophoresis for Acute, Subacute, Chronic, or Postoperative Plantar Heel Pain are not recommended – for the management of surgical, chronic, or subacute plantar heel pain.

     

  19. Therapeutic Ultrasound for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis

    Therapeutic Ultrasound for Acute, Subacute, Chronic, or Postoperative Plantar Fasciitis are not recommended for the treatment of postoperative, chronic, subacute, or acute plantar fasciitis.

     

  20. Low-dose Radiation (Radiotherapy) for Chronic Plantar Heel Pain

    Low-dose Radiation (Radiotherapy) for Chronic Plantar Heel Pain is not recommended to alleviate persistent plantar heel pain.

Injection Therapy for Plantar Heel Pain

  1. Autologous Blood Injection for Acute, Subacute, or Chronic Plantar Fasciitis

    Autologous Blood Injection for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended for the treatment of either chronic or subacute plantar fasciitis.

     

  2. Botulinum Toxin A Injection for Acute, Subacute or Chronic Plantar Fasciitis

    Botulinum Toxin Injection for Acute, Subacute or Chronic Plantar Fasciitis is not recommended as a remedy for persistent plantar Fasciitis.

     

  3. Injections of glucocorticoids for chronic plantar fasciitis

    Injections of glucocorticoids for chronic plantar fasciitis are recommended for the short-term relief of severe or difficult-to-treat plantar fasciitis.

    Indications: Failures with stretching, exercise, and other non-operative therapy for moderate to severe plantar fasciitis.

    Frequency/Duration: A second injection may be given if the problem is incapacitating, all other treatment options have been exhausted, and the patient is aware and agrees that rupture is a possible complication and will likely necessitate surgery.

     

  4. Glucocorticosteroid Injections for Acute or Subacute Plantar Fasciitis

    Glucocorticosteroid Injections for Acute or Subacute Plantar Fasciitis is not recommended for treatment of acute or subacute plantar fasciitis.

     

  5. Guidance of Steroid Injection with Ultrasound or Scintigraphy

    Guidance of Steroid Injection with Ultrasound or Scintigraphy are not recommended in contrast to palpation.

     

  6. Hyperosmolar Dextrose Injections for Plantar Fasciitis

    Hyperosmolar Dextrose Injections for Plantar Fasciitis is not recommended in order to treat plantar fasciitis. The Case for Hyperosmolar Dextrose in the Treatment of Plantar Fasciitis

     

  7. Platelet Rich Plasma Injections for Plantar Fasciitis

    Platelet Rich Plasma Injections for Plantar Fasciitis is not recommended in order to treat plantar fasciitis. There is Support for the Use of PRP in the Treatment of Plantar Fasciitis

Surgery for Plantar Heel Pain

Surgery for Select Chronic Recalcitrant Plantar Fasciitis is recommended for those chronically resistant plantar fasciitis. There is no suggestion for any specific method over another procedure.

Indications: Patients with moderate to severe chronic plantar fasciitis whose problem has persisted for at least six to twelve months and who have tried numerous non-surgical treatments without success. Patients should typically have tried NSAIDs, extending the plantar fascia, injections, and other conservative treatments without success.

Rationale for Recommendations: Surgery is advised. as an intervention when other nonoperative treatments have been used for at least six months and the patient’s symptoms are severe enough to make surgical risks necessary. intervention. patients’ knowledge of inadequate Expected results is advised.

Surgery for Acute or Subacute Plantar Fasciitis

Surgery for Acute or Subacute Plantar Fasciitis are not recommended to treat plantar fasciitis that is either acute or subacute.

Other

  1. Orthotic Devices for Acute, Subacute, or Chronic Plantar Heel Pain

    Orthotic Devices for Acute, Subacute, or Chronic Plantar Heel Pain are recommended for the management of sudden, gradual, or persistent plantar heel discomfort.

    Indications: Patients with plantar fasciitis.

    Duration/Frequency: For two to three months, use every day. Resolution, unfavourable effects, and noncompliance are all grounds for discontinuation.

     

  2. Custom Orthoses for Acute, Subacute, or Chronic Plantar Fasciitis

    Custom Orthoses for Acute, Subacute, or Chronic Plantar Fasciitis are not recommended for plantar fasciitis that is acute, subacute, or chronic.

     

  3. Orthoses for Prevention of Plantar Fasciitis or Lower Extremity Disorders

    Orthoses for Prevention of Plantar Fasciitis or Lower Extremity Disorders are not recommended for the prevention of lower extremities problems such as plantar fasciitis.

     

  4. Cryosurgery for Subacute, Acute or Chronic Plantar Heel Pain

    Cryosurgery for Subacute, Acute or Chronic Plantar Heel Pain or not recommended to alleviate persistent plantar heel pain.

     

  5. Intracorporeal Pneumatic Shockwave Therapy (IPST) for Select Chronic Plantar Fasciitis

    Intracorporeal Pneumatic Shockwave Therapy (IPST) for Select Chronic Plantar Fasciitis is recommended for treatment of select chronic plantar fasciitis.

    Indications: It is advised to use IPST as an as an alternative to surgical treatment for stubborn plantar Patients with fasciitis who don’t respond to various non-operative treatments NSAIDs, injections, stretching, and other treatments having a visible heel (from exercises and night splinting) Spur.

     

  6. Percutaneous Calcaneus Fenestration for Chronic Plantar Heel Pain

    Percutaneous Calcaneus Fenestration for Chronic Plantar Heel Pain is not recommended to alleviate persistent plantar heel pain.

     

  7. Radiofrequency Microtenotomy for Chronic Plantar Fasciitis

    Radiofrequency Microtenotomy for Chronic Plantar Fasciitis is not recommended for treatment of chronic plantar fasciitis.

What our office can do if you have Plantar Heel Pain

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