Diagnosis
H&P
-Hx: Heel pain that is worse with the first steps in the morning or after prolonged rest.
-PE: Heel tenderness present. Palpation of the medial plantar calcaneal region elicits a sharp pain. Discomfort in the proximal plantar fascia elicited by passive ankle/first toe dorsiflexion.
DDx and etiology:
Risk Factors:
Treatment
Conservative treatment
-Rest, activity modification, ice massage (e.g. rolling foot over a frozen soda can or bottle), NSAIDs, Stretching exercises (calf stretch, and plantar fascia stretch), supportive shoes and foot orthotics, night splints, and physical therapy discussed with the patient.
Steroid injection if conservative treatment doesn’t work.
Surgery as last resort.
-Counseling: 90% of patients will improve with these conservative techniques. Patients with chronic recalcitrant plantar fasciitis lasting 6 months or longer can consider extracorporeal shock wave therapy or plantar fasciotomy.
-F/u in 4 weeks.
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Plantar fasciitis causes heel pain and tenderness of the plantar fascia where it inserts onto the medial tubercle of the calcaneus.
** Try Voltaren gel instead of po NSAIDs. There is some testimony of patients that it works amazingly well. No research yet.
Voltaren 1 % topical gel APPLY 2 GRAM TO THE AFFECTED AREA(S) BY TOPICAL ROUTE 4 TIMES PER DAY
http://orthoinfo.aaos.org/topic.cfm?topic=a00149
-Plantar fasciitis is characterized by pain that is worse with the first few steps in the morning or after a prolonged rest.
“-NSAIDs may help with the discomfort, but prompt relief of the pain by any modality is not common.
The pain is typically in the medial heel. While 50% of people with plantar fasciitis have heel spurs on radiographs, this finding is not causative or diagnostic. The diagnosis is made clinically.”ABFM
“The diagnosis of plantar fasciitis is based primarily on the history and physical examination. Patients may present with heel pain, and palpation of the medial plantar calcaneal region may elicit a sharp pain. Discomfort in the proximal plantar fascia can be elicited by passive ankle/first toe dorsiflexion. Diagnostic imaging is rarely needed for the initial diagnosis of plantar fasciitis. In recalcitrant plantar fasciitis plain films may be helpful for detecting bony lesions of the foot. Ultrasonography is inexpensive and may be useful for ruling out soft-tissue pathology of the heel in some patients. While MRI is expensive, it is a valuable tool for assessing causes of recalcitrant heel pain.”ABFM
Am Fam Physician 2011;84(6):676-682.
Am Fam Physician 2011;84(8):909-916.