ACFAS Guidelines on Heel Pain

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Posted by Ed Davis, DPM on 11/06/05 at 17:44 The following are guidelines as set forth by the American College of Foot and Ankle Surgeon in 2001. Since then, we have had advances in ESWT, cryosurgery/cryoanalgesia such that the surgical treatment of heel pain shoould be a statistically infrequent event.

The Diagnosis and Treatment of Heel Pain

Click the following link to download the ACFAS Heel Pain Clinical Practice Guideline in pdf format.

The Diagnosis and Treatment of Heel Pain (443 KB)

The above may not come out as an active link. If so, please go to http://www.acfas.org to obtain the relevant information.

Ed Davis, DPM, FACFAS
Reply to Message # 186844

Re: ACFAS Guidelines on Heel Pain: advice for readers, request to ScottR
Posted by Ed Davis DPM on 11/07/05 at 10:58 Please keep in mind that the ACFAS is an ethical organization which formulates guidelines, not rules. It is the pre-eminent organization representing podiatric surgery in North America so it it a "pro" surgery organization. Even with the knowledge base available for its 2001 guidelines which include decision making flowcharts, the pathway to surgery is NOT a fast one. A reasonable amount of conservative care should be rendered.

ScottR:
Please consider publishing the ACFAS Guidelines with decision making pathways flowchart as a permanent feature on this board.
Ed
Reply to Message # 186873

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by Ed Davis DPM on 11/07/05 at 11:04 I would encourage readers to consult the online surgery guidelines as published by the ACFAS (American College of Foot and Ankle Surgeons). They are a free download in PDF format.

ScottR: Can we use the PDF files and somehow link to them?. Programs such as "Solid Convertor" can change PDF files to Word Documents. I believe that the ACFAS has no restrictions on their use by the public or commercially. http://www.acfas.org
Ed

Ed Davis, DPM, FACFAS
Reply to Message # 186874

ACFAS, ScottR
Posted by Ed Davis DPM on 11/07/05 at 11:17 ScottR:
I am a member of the ACFAS but am not here to represent nor am I authorized to represent them. I beleive that their published professional guidelines which were the result of a huge collaborative effort and many hours of hard work really represent the "bottom line" when it comes to most foot and ankle surgery. Foot surgeons who are MDs or DO's, I beleive, do not have preactice philosophies that inconsistent with the ACFAS Guidelines except for a small percentage of practitioners. I strongly recommend that an online surgery board attempt to let readers realize the existence of the Guidelines and use the Guidelines as an OBJECTIVE reference. If I was to have foot/ankle surgery, a member of my family, one of my patients, I would encourage them to consult those Guidelines (it is like getting a free consultation with many of the top foot/ankle surgeons in North America).
Ed

Ed Davis, DPM, FACFAS
Reply to Message # 186876

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by scott r on 11/07/05 at 11:29 If I can move the PDF file to heelspurs.com, I'll make an automatic link. Their web site has a copyright notice, but the PDF does not, so you may be right about their freedom of use policy. It was interesting to see surgery wasn't in the graphical part of the plantar heel pain pathway. The graphical part of the pathways could have been more detailed and exhaustive.
Reply to Message # 186881

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by Ed Davis DPM on 11/07/05 at 15:24 ScottR:

You may remember (it was a long time ago) that when I came to the site in August 2001, I stated that a flow chart was needed but knew that ACFAS was coming out with one in a few months. I did not introduce the ACFAS flow chart back then for the exact reason you just mentioned. The importance of their flow chart, I believe, is to demonstrate that a well respected surgical organization is basically telling everyone that there is a fairly long pathway to surgery on the plantar fascia.

I hsve tried to "improve" on the flowchart but it is not really that easy due to all of the treatment choices, not to mention combination of treatments. I would like to see someone else try though. The flowchart does not have to be perfect and we could look at more than one...
Ed
Reply to Message # 186900

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by Dr. David S. Wander on 11/07/05 at 16:12 Ed, today I received one of the journals (I forget if it was Podiatry Today or Podiatry Management) with an article by Steve Barrett, DPM. It's interesting because he invented the EPF procedure and is now writing about the fact that plantar fasciitis should be called plantar fasciosis and that many heel pain patients are misdiagnosed and have a neurogenic component to their heel pain. As a result he is performing a nerve release as per Dr. Dellon and is advocating testing with the pressure sensitive device vs. an EMG/NCV. (He is a shareholder in the company that makes the device). He is also writing about autologous blood injections with growth factors to heal the fascia. The bottom line is that the ACFAS flow chart may have a few more pathways if you read Dr. Barrett's article. It's interesting that he invented the EPF yet now seems to have gone full circle with his treatment regimen.
Reply to Message # 186907

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by Dr. Z on 11/07/05 at 16:24 David
I think its called experience
Reply to Message # 186909

Re: ACFAS Guidelines on Heel Pain, other foot surgery
Posted by Ed Davis DPM on 11/07/05 at 18:22 You both are on the mark as usual.
Ed
Reply to Message # 186920