As an orthopaedic surgeon in one of the largest foot and ankle subspecialty departments in the United States, Andrew Hanselman, MD, offers innovative solutions for a wide range of complex deformities and common pathologies. In this Q&A, Hanselman provides considerations for chronic heel pain that can mimic other conditions and discusses trends in weight-bearing after surgery.
Q: What types of acute, nonsurgical issues should be seen by a foot and ankle specialist?
Hanselman: Common pathologies such as ankle sprains, bunions, plantar fasciitis, Achilles disorders, and chronic heel pain are things I see every day in clinic, and they are just as important to have someone managing appropriately. These ailments can be equally as debilitating as the big, complex cases and really keep people out of work and away from their day-to-day lives.
There are certainly a lot of great primary care providers who do a good job of controlling these issues, but for patients who need further care to guide them through to getting better, that's where a foot and ankle specialist comes into play.
Q: For patients with chronic heel pain, what other diagnoses might be considered besides plantar fasciitis?
Hanselman: There are numerous other medical conditions that can mimic the plantar fascia heel pain, including tarsal tunnel syndrome and heel stress fractures. A lot of times, back and spine issues can also lead to heel pain. With heel stress fractures, you have to treat that differently than you would just regular plantar fasciitis by immobilizing patients for at least four weeks; otherwise, prescribing specialized stretches and physical therapy might just be aggravating the real problem.
We try to manage these patients non-operatively as much as possible and try to reassure them that it is going to get better with time and that there are things we can do nonsurgically to speed up that process.
Q: When surgery is necessary, how is Duke approaching weight-bearing after surgery?
Hanselman: A lot of studies coming out now show that when we keep people off their feet postoperatively to allow them to heal, it is sometimes detrimental to a patient, including muscle atrophy and coordination issues. Some of the newer technology for bunion surgery we’re using at Duke enables people to get back on their feet after just a few weeks. Even with cases like ankle fractures, we're starting to see that in the right patients, weight-bearing earlier will only help them in the long run get back to their activity.