CC May 2016 Plantar Fasciitis

echoecho's version from 2016-09-16 00:53


Question Answer
What is a common cause of heel pain in adults?plantar fasciitis
As with many orthopedic conditions that were once thought to be caused by?acute inflammation, current theories of plantar fasciitis support degenerative changes due to multiple micro-tears in the plantar fascia with overuse, leading to the term "plantar fasciosis"
List risk factors?1) pes planus 2) pes cavus 3) excessive running 4) obesity 5) prolonged standing or walking 6) sedentary lifestyle
List biomechanical risk factors?1) overpronation 2) limited ankle dorsiflexion 3) weak intrinsic foot muscles 4) weak plantar flexors
Where is the pain typically located?medial plantar calcaneal region of the foot
When is the pain worse?after periods of inactivity upon awakening in the morning (first step phenomenon) and improves with ambulation, however can become worse at the end of the day with reactivation of plantar stretch following a rest period
Is the pain gradual or sudden on onset?gradual
What is the exam findings?tenderness at the medial insertion of the fascia to the calcaneus and may demonstrate pain on passive dorsiflexion of the great toe
Swelling and ecchymosis are not present unless there has been what?direct trauma or a rupture of the fascia
Is imaging necesary in the initial work-up fo plantar fasciitis?no
Does the presence of a calcaneal spur on plain x-ray correlate with the dx or indicate the severity of plantar fasciitis?no
Criteria for the dx of plantar fasciitis exist for both _____ and _____? These tests are usually not indicated unless the dx is what?1) US; MRI 2) dx is uncertain or pain persists despite conservative therapy
Conservative management of plantar fasciitis results in the improvement in up to ____% of affected patients over a course of several months?90%
Resoluation with an modality of treatment takes ___ to ____ weeks and switching to alternative forms of therapy should be avoided until an adequate trial is completed?6-8
Patients should be instructed to avoid what?activities that exacerbate their symptoms
Patients should be encouraged to do what periodically if their job involves sitting for prolonged periods?get up periodically during the day
Runners may need to temporarily decrease what of their training?frequency and/or intensity
List other suggested treatment?1) applying ice to the affected area 2) weight loss 3) use of well-fitting supportive footwear 4) judicious use of acetamiophen or NSADs
*** Progressive stretching of what part of the foot muscles has been shown to improve the pain of plantar fasciitis?1) plantar fascia 2) intrinsic foot muscles
What type of exercises have hnot been studied extensively in plantar fasciitis but have been shown to be beneficial in other tendinopathies?Eccentric exercises (exercies performed under load while the muscle is slowly lengthened)
What treatment can be used to correct intrinsic foot problems (overpronation) which predispose patients to plantar fasciitis?foot orthotics
*** A Cochrane review failed to show superiority of custom foot orthotics over prefabricated foot orthotics for pain relief, true or false?true
What treatment can be used to keep the affected foot in neutral position at night, thus preventing plantar flexion during sleep?night splints
Although beneficial, many patients are unable to tolerate night splints due to what?sleep disturbances from wearing the device
What treatment may be more appropriate in chronic plantar fasciitis?injections into the plantar fascia
Cortisone injections should be reserved for what?secondary treatmen tafter failure of one or more conservative modalities
What are the complications of steroid injections?loss of plantar fat pad and potential fascial rupture
List other injectable agents that are currently being studied?1) hyperosmolar dextrose 2) whole blood 3) platelet-rich plasma 4) botulinum toxin
What shock therapy has shown effectiveness in a recent meta-analysis but should be reserved for conservative treatment failures?Extracorporeal shock wave therapy
What intervention may be considered when other approaches have failed to give relief?surgical intervention
*** SUMMARY: Define plantar fasciitis?a painful condition arising at the proximal plantar fascial insertion to the calcaneus, is more appropriately attributed to micro-tears than to an inflammatory process
*** SUMMARY = Conservative management with stretching, orthotic devices and analgesics isi usually effective within _____ months?3
*** SUMMARY = Historical features and physical exam should be able to distinguish this disorder from what other causes of foot pain?1) stress fracture 2) calcaneal injury 3) Achilles tendinopathy