74: Heel Pain - Smith Flashcards Preview

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Flashcards in 74: Heel Pain - Smith Deck (11)
1

define plantar fasciitis

 

Plantar stress, tendinitis and inflammation of the plantar fascia with or without a spur or inferior calcaneal exostosis

2

how often is a spur assoc with heel pain?

11% of US population and 73% of patients with heel pain have a spur

"heel spur syndrome"

3

etiology PHP

  • Repetitive traction with inflammation
  • Pronation
  • Increased body weight or activity
  • Systemic or Rheumatological disorders

4

diagnositc s/s PHP

  • Radiating, deep aching heel pain
  • Poststatic Dyskinesia    [pain in morning, gets better throughout day OR pain after sitting, gets better w/ movement]
  • Pain of palpation, Hubscher Maneuver [dorsiflex hallux to recreate windlass mech ]
  • Radiographs - Saddle Sign [actually seeing the spur, xray upside down looks like a saddle]
  • Laboratory Studies - only if worrying about infection
  • Bone Scans - if not responding to conservative tx, pain with compression of calcaneal tuberosity w/ increased activitiy hx
  • MRI - looking for bone cyst, bone tumor

5

heel spur

6

tx options

  • Taping (low dye)
  • NSAIDs
  • Ice
  • Physical therapy (stetching PF, achilles)
  • Orthotics
  • Injections/Medrol Dose Pack (injection/oral with anti-inflammatory corticosteroids)
  • Night splints or straussburg sock
  • Immobilization
  • Platelet-Rich Plasma (injection and trauma inducing)
  • Surgery

7

what is plantar fasciotomy?

  • plantar fascial release with or without spur resection
  • instep fasciotomy, open fasciotomy or endoscopic plantar fasciotomy (EPF)

8

which plantar fasciotomy allows for spur resection?

only open fasciotomy

9

describe instep fasciotomy

  • Incision in medial arch anterior to calcaneus
  • Medial portion of fascia released
  • (+) recovery, visibility
  • ( - ) no resection of exostosis

10

describe open fasciotomy

  • medial incision to visualize the plantar fascia
  • fascia isolated superior and inferior
  • (+) visibility, resection of exostosis
  • ( - ) recovery (crutches 2-3 wks), wound complications, neurological complications (medial branch calcaneal). and hematoma

11

describe endoscopic plantar fasciotomy

  • use of an endoscope to visualize and cut the plantar fascia
  • ( + ) recovery, visibility
  • ( - ) no resection of exostosis

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