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July 3, 2005
By the way...I've got

I know this may seem cursory but I had a patient come in with the ambiguous "foot pain".  I, not having interest nor a fetish for feet feel disgusted at times and tend to shy away from these problems.  However, they are unavoidable in the FP clinic. A patient may come in with difficult breathing or heartburn and will "oh, by the way, doc" regarding some foot condition.  Yuk.  Anyway, sometimes the problem is relatively easy and can be fixed by some encouraging words and prescriptions.  Here is one such case, here is my story...

Senor Paco had been walking extensively the past five years or so since his retirement and has not had any problems until about 6 months ago when he began to have intermittent pain in the sole of his right foot.  It was an intense, sharp pain that seemed to radiate from the heel towards his toes, most intense in the heel to mid-foot.  It felt burning at times with more pain with walking or other loading exercises.  Over the past few weeks the pain was most intense the first few steps upon getting out of bed and this prompted his visit to the clinic.

Without any further testing, what is the diagnosis?

Plantar fasciitis (American Family Practice Article) , until proven otherwise. The above complaints are the classic symptoms and description.

Conservative Treatment

  • Rest (limit activities)
  • Ice
  • Supportive shoes and/or OTC orthotics or heel cups
  • Lose weight if an issue
  • Stretching (those listed on website and by pulling upper foot/toes toward shin)
  • NSAIDS

Progressive Treatment

Radical Treatment

Posted At : 10:39 PM. | Link | Rotation 6 04-05 | Comments (7)

Current Rating:
(4)

Comments

Really?! Extracorporeal shock therapy? In the link to the article, it looks like a glorified massager. The applications it is good for looks varied too. Ehh. I guess that's how docs make money. Call it something with a cool sounding name.

Posted By Garrick Tong / Posted At 7/9/05 12:28 PM

I saw a pt who had a "calcified" shoulder and tried ECSW therapy with relief b/c the steroid shots had not worked for them. It was the first time i had heard of this therapy and I agree with Garrick, it looks like an expensive massager! Whatever works.

Posted By Tisha Baird / Posted At 7/9/05 4:34 PM

Awesome website on plantar fasciitis by the AFP. I haven't seen any foot pain yet but I'll keep my eye out.

Posted By Scott Pregont / Posted At 7/9/05 7:00 PM

I have definitely seen a few cases of plantar fasciitis and it is interesting that the only conservative treatments I have seen are NSAIDS and orthotics. I haven't heard the physicians stressing weight loss (since everyone is obese), ice, or even rest. Sometimes I think it is easy to forget the conservative treatments that may seem obvious to us.

Posted By Diana Kim / Posted At 7/9/05 7:32 PM

The best conservative treatment that I have seen for plantar fasciits was given by the orthopedists (go figure!), they always gave the patients hand-outs showing the proper ways to do the stretching exercises. In IM and FP I have seen the same thing as Diana - NSAIDs and orthodics. The exercises are simple enough and these exercises should be showed to pts or hand-outs given out to them.

Posted By Ann Ostrovsky / Posted At 7/10/05 9:09 AM

I have seen ice, NSAIDS, orthotics, and rest stressed as conservative therapy for plantar fascitis, as well as the exercise handout in the office. But, we had a patient (a runner) who had been diagnosed with plantar fascitis, but after 2 months of conservative therapy without improvement, later X-rays finally showed a stress fracture. So I would keep that in mind in the differential, especially in very active patients.

Posted By Nardin Tadros / Posted At 7/10/05 5:08 PM

Plantar fasciitis is a real hassle. The few cases that I've seen, the patients were walking a lot and both of them were walking in flip flops consistently. Aside from rest which may not be attainable, I've seen good results with the heel cups along with not walking long distances in flip flops.

Posted By David Neskey / Posted At 7/10/05 6:14 PM