Plantar fascia rupture associated with corticosteroid injection

Adequate conservative therapy of plantar fasciitis, as described above, must be pursued for several months before any surgical intervention is contemplated. It is unwise to operate on a patient who has had only a limited trial of conservative treatment and who has incomplete control of the abnormal mechanics that have caused the symptoms. Surgical intervention may be indicated in the small percentage of patients who have failed to benefit from conservative methods and who still have significant plantar heel pain after a lengthy period of treatment.

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The injury is usually quite painful and therefore initial treatment is generally oriented towards pain control with ice, crutches and limited activity. As the symptoms begin to settle, often 4-10 days after the original injury, it may be possible to do more weight bearing, provided that stiff soled comfort shoes or a protective walker boot is used. At this point, gentle plantar stretching can be done.  Non-steroidal anti-inflammatory medication (NSAIDs) or pain medication can help with the symptoms. Return to reasonably normal standing or walking can occur relatively quickly in a few weeks. However, return to high level sports requiring sudden change of direction or explosive power through the plantar fascia region can be quite prolonged, in the order months.

Patient history is the most important tool for diagnosis of plantar fasciitis. Gradually onset of pain on the bottom of the heel, generally toward the inside of the arch, which is sharp or dull with walking and achy at rest, worse at the first step in the morning , or getting up after long periods of rest, is almost diagnostic for plantar fasciitis. On exam, the patient usually will have pain with palpation (pressure) at the inside of the heel, sometimes it will make a person jump or even bring tears to the eyes when it is very inflamed. There is occassionally pain at the back of the heel or along the inside of the arch. The inside of the heel is the origin of the plantar fascia and the area that is under the greatest amount of stress. This areas is generally the first to tear and weaken, and therefore have the most pain.

The plantar fascia also has an important role in dynamic function during gait . It was found the plantar fascia continuously elongated during the contact phase of gait. It went through rapid elongation before and immediately after mid-stance, reaching a maximum of 9% to 12% elongation between mid-stance and toe-off. [3] During this phase the plantar fascia behaves like a spring, which may assist in conserving energy. In addition, the plantar fascia has a critical role in normal mechanical function of the foot, contributing to the "windlass mechanism". When the toes are dorsiflexed in the propulsive phase of gait, the plantar fascia becomes tense, resulting in elevation of the longitudinal arch and shortening of the foot (see 3A). One can liken this mechanism to a cable being wound around the drum of a windlass (see 3B); the plantar fascia being the cable, the metatarsal head the drum, and the handle, the proximal phalanx .

Plantar fascia rupture associated with corticosteroid injection

plantar fascia rupture associated with corticosteroid injection

Patient history is the most important tool for diagnosis of plantar fasciitis. Gradually onset of pain on the bottom of the heel, generally toward the inside of the arch, which is sharp or dull with walking and achy at rest, worse at the first step in the morning , or getting up after long periods of rest, is almost diagnostic for plantar fasciitis. On exam, the patient usually will have pain with palpation (pressure) at the inside of the heel, sometimes it will make a person jump or even bring tears to the eyes when it is very inflamed. There is occassionally pain at the back of the heel or along the inside of the arch. The inside of the heel is the origin of the plantar fascia and the area that is under the greatest amount of stress. This areas is generally the first to tear and weaken, and therefore have the most pain.

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