What is the appropriate work accommodation for a 52-year-old female with a history of myalgia, hypertension, and varicose veins, currently experiencing bilateral heel pain, who is under the care of a podiatrist and has recently received heel injections?

From the Guidelines

The patient requires a work accommodation note to access padding to stand on or a chair to sit in during long work hours to manage her bilateral heel pain, which is being overseen by podiatry specialists. This 52-year-old female with a history of myalgia, hypertension, and varicose veins presents for follow-up regarding bilateral heel pain. She is currently under podiatry care with regular follow-up appointments. The patient previously attempted to manage her pain with heel inserts and most recently received heel injections on April 16,2025.

Key Points

• The patient's heel pain management is being overseen by podiatry specialists, as recommended by 1.
• Initial treatment options for heel pain may include patient-directed measures such as regular calf-muscle stretching, cryotherapy, over-the-counter heel cushions and arch supports, weight loss (if indicated); activity limitation; and avoidance of flat shoes and barefoot walking, as suggested by 1.
• The patient's request for a work accommodation note is reasonable, given her ongoing heel pain and the need for padding or a chair to sit in during long work hours.
• The patient's symptoms of gas and stomach bloating are likely unrelated to her heel pain, but rather attributed to poor dietary choices, specifically mentioning a bean burrito consumed the previous night.

Heel Pain Management

The patient's heel pain management is being overseen by podiatry specialists, which is in line with the recommended approach for individuals with high-risk feet, as stated in 1. The use of heel inserts and corticosteroid injections, as mentioned in 1 and 1, are also part of the patient's treatment plan.

Work Accommodation

The patient should be provided with a work accommodation note to access padding to stand on or a chair to sit in during long work hours, as this is a reasonable request to manage her bilateral heel pain. This accommodation is likely to improve the patient's quality of life and reduce her morbidity, as it will allow her to work comfortably and reduce her heel pain.

From the Research

History of Present Illness

• The patient is a 52-year-old female with a history of myalgia, hypertension, and varicose veins, presenting with bilateral heel pain.
• She is under the care of podiatry with regular follow-up and has previously tried heel inserts for relief.
• The patient recently received heel injections on 4/16/25.
• She is requesting a note for work to have access to stand on padding or a chair to sit in during long hours.
• The patient is also reporting gas and stomach bloating, which she attributes to not eating ideally, specifically after consuming a bean burrito the previous night.

Relevant Studies

• A study published in 2003 2 found limited evidence for the effectiveness of various treatments for plantar heel pain, including steroid injections, orthotic devices, and physical therapy.
• A 2017 study 3 found low-quality evidence that local steroid injections may slightly reduce heel pain up to one month but not subsequently.
• A 2019 systematic review and meta-analysis 4 found that corticosteroid injection was more effective than some comparators for reducing pain and improving function in people with plantar heel pain, but not more effective than placebo injection.
• A 1999 systematic review 5 found that the few randomized controlled trials on treatments for plantar heel pain did not provide robust scientific evidence of treatment efficacy.
• A 2020 systematic review 6 found that ultrasonography-guided local corticosteroid or anti-TNF injections were effective and safe modalities for the treatment of inflammatory heel enthesitis, tendinitis, and retrocalcaneal bursitis in patients with rheumatic inflammatory diseases.