4.4 of 54 Ratings
A 48-year-old female presents with acute-on-chronic heel pain. She had been training for a marathon for 3 months when she felt an acute pop near her heel and has been unable to bear much weight since. Prior to this event, pain only occurred during the beginning of her runs and slowly subsided. Her family physician had placed her on a regimen of daily stretching and night-time splinting for 2 months prior to this incident, but also administered a pain shot in this area 3 weeks ago. She denies recurrent ankle sprains. What finding do you expect on physical exam and what is her diagnosis?
Pain with resisted toe flexion, symptomatic os trigonum
Pes planus, rupture of the plantar fascia
Pes cavus, peroneal tendon subluxation
Pes planus, posterior tibial tendon insufficiency
Lateral ankle swelling, lateral talar process fracture
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A 36-year-old male recreational golfer has been complaining of left plantar heel pain for nearly 6 weeks. His pain is worse with weight-bearing, especially the first steps in the morning or after long periods of rest. To date, he has been treating his pain with anti-inflammatory medications and physical therapy. His pain had improved by approximately 40% with these modalities, but the improvements are starting to plateau. What would you recommend next for treatment of his condition?
Stop physical therapy and prescribe custom orthotics
Administer bi-weekly extracorporeal shockwave therapy to the heel
Endoscopic plantar fasciotomy
Bipolar radiofrequency to the heel
For the treatment of new onset plantar fasciitis, which of the following modalities results in the highest patient satisfaction at 8 weeks of follow-up?
Isolated Achilles tendon–stretching program
Extracorporeal shock-wave therapy
Plantar fascia–specific stretching program
Distal tarsal tunnel decompression and partial plantar fascia release
A 34-year-old female has an insidious onset of heel pain when first getting out of bed and at the end of the day after prolonged standing. She works as a waitress and recently had bariatric surgery with a current BMI of 35. She has a gastrocnemius contracture noted on Silverskiold testing. AP and oblique radiographs are shown in Figure A and lateral radiograph is shown in Figure B. What is the most likely diagnosis?
Navicular stress fracture
First branch of the lateral plantar nerve (Baxter's) entrapment
Anterior tarsal tunnel syndrome
A 44-year-old recreational runner began training for a half marathon 6 weeks ago. Over the last week he has developed heel pain that is worse in the morning upon awakening and when he arises from his desk at the end of the workday. Physical exam is notable for tenderness with direct palpation of the anteromedial heel. Which of the following is the best initial management?
Stretching of the achilles tendon and plantar fascia along with a prefabricated shoe insert
Immobilization in a short leg cast
Steroid injection of the plantar fascia
Custom made orthotic with arch support
Surgical release of the medial third of the plantar fascia origin
A 40-year-old female presents to the physician for an initial visit with a 5-month history of plantar medial heel pain. She notices it immediately on getting out of bed in the morning, but the pain improves after a few steps. The pain is exacerbated throughout her workday to the point where she is unable to finish her work shift. Figure A shows a lateral radiograph of the affected heel. Which of the following is the most appropriate initial management?
Walker boot immobilization with full weightbearing for 4 weeks
Corticosteroid injection to the plantar fascia
Surgical release of 50% of the plantar fascia
Heel spur resection
Achilles stretching exercises