MEHPS—Multiple Etiology Heel Pain Syndrome

Robert G. Parker
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Dr. Parker is a podiatrist and surgeon in Houston, TX who has been helping patients for more than 40 years.

Heel in PainYou may have hated pop-up quizzes in high school, but when you visit our office with heel pain, we may give you one that could save you months of discomfort. There’s nothing to hate about that! It’s called the MEHPS questionnaire, and along with other diagnostic tools and tests, it helps us pinpoint the exact cause of the pain in your heel.

Plantar Fasciitis or MEHPS?

For decades the overwhelming diagnosis for heel pain has been plantar fasciitis. Even though newer research indicates that there is often no inflammation (“itis”) involved in the pain you may feel, treatment still often focuses on it with the use of nonsteroidal anti-inflammatory and steroid medications.

A more correct term for pain involving the plantar fascia might be plantar fasciopathy, since the problem is more likely to be degeneration of the ligament rather than inflammation in it. However, it may be equally likely that the problem isn’t with the fascia at all, but rather nerve entrapment under the heel, fat pad deterioration, spurs, or some other cause. That’s why the term MEHPS—multiple etiology heel pain syndrome (etiology is the study of the causes of a condition)—may be more accurate for your condition.

MEHPS Questionnaire

This clinical tool was developed by Stephen L. Barret, DPM—a close colleague of Dr. Parker’s—to help diagnose pain in your heel. We use it to help you evaluate each foot separately for when you feel discomfort, what type it is, what you are doing at the time, whether it worsens, and so on. Based on your answers (no=0, rarely=1, sometimes=2, yes=3) we assign a score that can tell us whether it is a simple plantar fascia issue, a nerve issue, or a combination of both that is causing your pain.

This tool is used in conjunction with diagnostic ultrasound (DUS), which gives a better picture of soft tissues like the plantar fascia than an X-ray could. DUS can show that status of the fascia, and also may indicate other problems such as tarsal tunnel syndrome or neuritis. Along with our observations and manipulation of your foot, these tools can give us a much truer picture of your issue.

This process also helps steer us to a treatment plan that really works. NSAIDS and steroids won’t do much for an entrapped nerve, so why waste time and money—not to mention months of continued discomfort—trying to fix a problem with the wrong solution? Even if it is plantar fasciopathy, a good diagnosis should delve more deeply into the grade of the condition and tailor the treatments for what will work best in your particular situation.

Come to the Heel and Nerve Pain Experts in Houston

Heel pain is not a one-size-fits-all problem. The staff at Parker Foot & Ankle will use the time and tools necessary to narrow down the cause and locate the underlying problem. Whether it is some degree of plantar fasciopathy, MEHPS, an entrapped nerve, or another condition altogether, we have the knowledge and expertise to find the answer for your sore heels.

You can call our office in Houston, TX at (281) 497-2850 to set up an appointment, or schedule online using our contact page. When you do, know that we will work to help you find health for your feet, ankles and all the rest of you. Check us out on Twitter, Facebook, Pinterest, or Google+ to discover more foot care information and help your feet stay happy.