46: Heel Pain - Frush Flashcards Preview

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1

etiology of majority of heel pain

mechanical heel pain

2

plantar mechanical heel pain

plantar fasciitis PLFS
apophysitis

3

posterior mechanical heel pain

achilles tendonitis
haglund's deformity
bursitis
apophysitis

4

insertional pain at attachment of plantar fascia with or without heel pain

plantar fasciitis

5

s/s plantar fasciitis

- post static dyskinesia (pain upon arising in the morning or from seated position)
- pain decreases after a few steps, returns later in day
- unilateral
- no inciting incident

6

PE plantar fasciitis

- high BMI
- equinus
- pain with palpation of inferior-middle, inferior-mdial or medial heel (max point is usually more medial0
- rarely edema or erythema found
- PRONATION 90% or pes cavus

7

1st line tx PHP

- padding and strapping of the foot
- therapeutic orthotic insoles
- oral anti-inflammatory med
- cortisone injection
- achilles and plantar fascia stretching

8

which is better for PHP achilles or plantar fascia stretching?

plantar fascia

9

2nd line tx plantar fasciitis

- custom orthotic devices
- night splint
- repeat cortisone injections
- botulinum toxin
- PT
- cast or boot immobilization

10

3rd line tx PHP

- endoscopic plantar fasciotomy
- extracorporal shock wave therapy
- bipolar radiofrequency

11

POSTERIOR heel pain ddx

insertional achilles tendonapthy, enthesopathy, haglund's, bursitis

12

tx achilles tendonitis

- heel lifts, open back shoes
- ice
- gentle stretching until onset of pain
- NSAID
- no corticosterioids
- PT iontophoresis
- activity modification
- immobilization w/asst or CAM

13

radiographic findings for haglund's defromity

- lateral view
- fowler and philip greater than 75
- total angle greater than 90
- parallel pitch lines - prominence protrudes above superior line

14

irritation of open growth plate

apophysitis
aka sever's disease

15

baxter's nerve

muscular branch to abductor digiti minimi from lateral plantar n.

16

s/s n entrapment

- manifest with some sort of unilateral paresthesia or pain
- bilateral symptoms suggest systemic problme
- tinels or valleix will be positive

17

FRESH EGGS for heel pain you can't figure out

F - fibromyalgia
R – Rheumatoid arthritis
E – enthesopathy (pain at insertion of soft tissue into bone)
S – spine pain, sore throat, sleep disturbance
H - headaches
E – eye infection or inflammation
G – GI problems
G – GU problems
S – sores or skin abnormalities

18

what are bywater lesions

bony prominences on calcaneus related to certain arthrities

19

heel pain elicited by squeezing sides of calcaneus

highly suspicious calcaneal stress fractures