Stephen L. Barrett, D.P.M. books S1 Ep 6 and 7

Show Notes

Dr. DuCasse  02:42

Okay. So we want to jump into this heel pain. First of all, I think heel pain has been the bane of, you know, the existence of many podiatrists and podiatric surgeons, figuring out the etiology of the heel pain. Most of the patients we see, in our practice, have heel pain, you’ve certainly seen a lot of heel pain. How did you get into managing heel pain? When you first started out? How did you evolve?

Dr. Barrett  03:11 discusses the evolution of the treatment of heel pain in the last 30 years and how EPF (endoscopic plantar fasciotomy) was integrated into the profession. The 652 patient multi surgeon study LINK is discussed as well as the early patient responses to EPF. The meta-analysis by Anderson and Foster comparing fasciotomy to fasciotomy with spur resection. LINK

Dr. Barrett  08:22 discusses the profession’s fixation on the heel spur.

Dr. Barrett  08:41 talks about the early push back against EPF.

Drs. DuCasse and Barrett  11:23 is plantar fasciitis really inflammatory?

Dr. Barrett  13:28 discusses the early integration of Diagnostic Ultrasound into the management of heel pain.

Dr. Barrett  15:34 illustrates the staging and grading of plantar fasciitis.

Dr. Barrett  17:31 does heel pain need to really be treated 6 months with failed conservative care?

Dr. DuCasse  17:47 Plantar Fasciopathy versus Fasciitis

Dr. Barrett  18:31 talks about multiple etiology heel pain syndrome (MEHPS) and ruling out neurogenic heel pain. Differential diagnoses for heel pain and how important the HPI is in formulating an accurate diagnosis.

Dr. Barrett  20:25 What about Equinus?

Dr. DuCasse  23:39 Has the treatment of heel pain overall really gotten any better over the last 3 decades?

Dr.  Barrett  24:53  discusses the ability of practitioners to really be able to accurately place injections without ultrasound.

Stephen Barrett  26:48 Can you really hold yourself out as an expert in heel pain if you do not implement diagnostic ultrasound in your work up of the heel pain patient?

Dr. DuCasse  29:20 The court of last resort.

Dr. Barrett  31:33 Is it a mouse or elephant?

Dr. DuCasse  33:25 discusses the literature.

Dr. DuCasse  36:13 talks about the reluctance of some physicians to integrate new ideas and understanding to their clinical regimens.

Dr. Barrett  36:47 goes over the early history of PRP. The efficacy and safety of using PRP and other injectables.

Dr. Barrett  38:11 Peptides—BPC 157

Dr. DuCasse  40:54 How can you change one’s central theory

Drs. DuCasse and Barrett 42:22 What about X-rays—are they valid? The Li and Muehleman study LINK

Dr. Barrett  44:46 The Dunning Kruger effect LINK

Dr. Barrett  45:32 Staying off Mt. Stupid

Dr. DuCasse  46:59 but those are kind of the ones you fixate on the ones that you can’t figure out exactly what’s happening, right.

Dr. Barrett  47:04 The Surgeon Heuristic