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Stretching of the achilles tendon and plantar fascia along with a prefabricated shoe insert
93%
1993/2143
Immobilization in a short leg cast
4%
81/2143
Steroid injection of the plantar fascia
1%
20/2143
Custom made orthotic with arch support
2%
37/2143
Surgical release of the medial third of the plantar fascia origin
0%
6/2143
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The clinical presentation is consistent with plantar fasciitis. Initial treatment includes stretching of the plantar fascia and achilles tendon. Shoe inserts and heel cups may be beneficial in relieving symptoms as well. Symptoms often take up to 6 months or a year to resolve and surgical release of the plantar fascia should be reserved for the exceptionally recalcitrant cases. Pfeffer et al conducted a level 1 study of 236 patients with plantar fasciitis. All patients were treated with achilles tendon and plantar fascia stretching. The patients were then randomized to a custom orthotic or prefabricated insert. The patients who received a prefabricated insert demonstrated significantly greater improvement in clinical symptoms at 8 weeks. Harty et al conducted a biomechanical study of foot loading on live subjects. Lack of knee extension was associated with prolonged loading of the forefoot. The authors concluded that through the windlass mechanism of the plantar fascia, hamstring tightness may predispose the foot to development of plantar fasciitis. Illustration A demonstrates the proper technique of plantar fascia stretching through stabilization of the hindfoot and hyperextension of the toes. Illustration B demonstrates an achilles tendon stretch that also incorporates eccentric loading of the gastroc-soleus.
4.3
(25)
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