Plantar Fasciitis

1.A 36-year-old male recreational golfer has been complaining of left plantar heel pain for
nearly 6 weeks. His pain is worse with weight-bearing, especially the first steps in the
morning or after long periods of rest. To date, he has been treating his pain with anti-
inflammatory medications and physical therapy. His pain had improved by approximately
40% with these modalities, but the improvements are starting to plateau. What would you
recommend next for treatment of his condition?

1. Stop physical therapy and prescribe custom orthotics

2. Administer bi-weekly extracorporeal shockwave therapy to the heel
3. Endoscopic plantar fasciotomy
4. Bipolar radiofrequency to the heel
5. Night splints

PREFERRED RESPONSE ▼ 5

2.For the treatment of new onset plantar fasciitis, which of the following modalities results in
the highest patient satisfaction at 8 weeks of follow-up?

1. Achilles tendon–stretching program

2. Corticosteroid injection
3. Extracorporeal shock-wave therapy
4. Plantar fascia–specific stretching program
5. Distal tarsal tunnel decompression and partial plantar fascia release

PREFERRED RESPONSE ▼4

3.A 34-year-old female has an insidious onset of heel pain when first getting out of bed and
at the end of the day after prolonged standing. She works as a waitress and recently had
bariatric surgery with a current BMI of 35. She has a gastrocnemius contracture noted on
Silverskiold testing. AP and oblique radiographs are shown in Figure A and lateral
radiograph is shown in Figure B. What is the most likely diagnosis?

FIGURES: A  B     
1. Navicular stress fracture
2. Freiberg's Infraction
3. Plantar fasciitis
4. First branch of the lateral plantar nerve (Baxter's) entrapment
5. Anterior tarsal tunnel syndrome

PREFERRED RESPONSE ▼ 3

4.A 44-year-old recreational runner began training for a half marathon 6 weeks ago. Over the
last week he has developed heel pain that is worse in the morning upon awakening and when
he arises from his desk at the end of the workday. Physical exam is notable for tenderness
with direct palpation of the anteromedial heel. Which of the following is the best initial
management?

1. Stretching of the achilles tendon and plantar fascia along with a prefabricated shoe
insert
2. Immobilization in a short leg cast
3. Steroid injection of the plantar fascia
4. Custom made orthotic with arch support
5. Surgical release of the medial third of the plantar fascia origin

PREFERRED RESPONSE ▼1

5.A 40-year-old female presents to the physician for an initial visit with a 5-month history of
plantar medial heel pain. She notices it immediately on getting out of bed in the morning, but
the pain improves after a few steps. The pain is exacerbated throughout her workday to the
point where she is unable to finish her work shift. Figure A shows a lateral radiograph of the
affected heel. Which of the following is the most appropriate initial management?
FIGURES: A          

1. Walker boot immobilization with full weightbearing for 4 weeks

2. Corticosteroid injection to the plantar fascia
3. Surgical release of 50% of the plantar fascia
4. Heel spur resection
5. Achilles stretching exercises

PREFERRED RESPONSE ▼5