Flashcards in 46: Heel Pain - Frush Deck (19)
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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
