ABSTRACT
Heel pain, whether plantar or posterior, is predominantly a mechanical pathology although an array of diverse pathologies including neurologic, arthritic, traumatic, neoplastic, infectious, or vascular etiologies must be considered. This clinical practice guideline (CPG) is a revision of the original 2001 document developed by the American College of Foot and Ankle Surgeons (ACFAS) heel pain committee.
Subject(s)
Fasciitis, Plantar/complications , Heel , Pain Management , Pain/diagnosis , Practice Guidelines as Topic , Tendinopathy/complications , Achilles Tendon , Chronic Disease , Combined Modality Therapy , Fasciitis, Plantar/diagnosis , Fasciitis, Plantar/surgery , Female , Follow-Up Studies , Foot Diseases/diagnosis , Foot Diseases/therapy , Humans , Magnetic Resonance Imaging , Male , Orthopedic Procedures/methods , Pain/etiology , Physical Examination , Risk Assessment , Severity of Illness Index , Tendinopathy/diagnosis , Tendinopathy/therapy , Tomography, X-Ray Computed , Treatment OutcomeSubject(s)
Neuroma/diagnosis , Neuroma/surgery , Forefoot, Human , Humans , Metatarsus , Neuroma/therapyABSTRACT
The prevalence of diabetes mellitus is growing at epidemic proportions in the United States and worldwide. Most alarming is the steady increase in type 2 diabetes, especially among young and obese people. An estimated 7% of the US population has diabetes, and because of the increased longevity of this population, diabetes-associated complications are expected to rise in prevalence. Foot ulcerations, infections, Charcot neuroarthropathy, and peripheral arterial disease frequently result in gangrene and lower limb amputation. Consequently, foot disorders are leading causes of hospitalization for persons with diabetes and account for billion-dollar expenditures annually in the US. Although not all foot complications can be prevented, dramatic reductions in frequency have been achieved by taking a multidisciplinary approach to patient management. Using this concept, the authors present a clinical practice guideline for diabetic foot disorders based on currently available evidence, committee consensus, and current clinical practice. The pathophysiology and treatment of diabetic foot ulcers, infections, and the diabetic Charcot foot are reviewed. While these guidelines cannot and should not dictate the care of all affected patients, they provide evidence-based guidance for general patterns of practice. If these concepts are embraced and incorporated into patient management protocols, a major reduction in diabetic limb amputations is certainly an attainable goal.
