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Management focuses on activity modification, stretching, and heel pads/orthotics, with symptoms sometimes resolving over 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ValuesNotesCalculatorReverse ColorText Zoom  \nA54-year-old man comes to the office due to left foot pain.The patient has had progressively worsening pain for the last month since starting awalking program to help lose weight.He has been walking 2-3 miles each morning and has pain and a stabbing sensation in the sole of his leftfoot at the end of the walks.The pain usually improves with rest and typically does not recur during normal activity.The patient has usedibuprofen and ice for pain relief.He has type 2 diabetes mellitus;his most recent hemoglobin A1c was 7.9%.Medical history is also notable forappendectomy,cholecystectomy,and bilateral carpal tunnel release.Vital signs are normal.BMI is 36 kg/m².The left foot has a normal arch.When the toes are dorsiflexed,there is tenderness to palpation between the heel and forefoot.There is no pain with firm palpation along the backor sides of the heel.Sensation and range of motion are normal.Which of the following is the most likely cause of this patient's pain?○ A.Calcaneal stress fracture○ B.Charcot joint○ C.Heel spur○ D.Morton neuroma○ E.Plantar fascitisO F.Tarsal tunnel syndrome  \nSubmit  \nSettings  \n三×1 of 40tion Id:14026  \nAAA  \n卡  \n□o□□  \nMark  \nPrevious  \nNext  \nExit Mode  \nTutorial  \nNotes  \nLab Values  \nCalculator  \nReverse Color Text Zoom  \nSettings  \n\n| Plantar fasciitis   |  |  |\n| --- | --- | --- |\n| Risk factors   | ·Pes planus  \u003Cbr>·Obesity  \u003Cbr>·Working or exercising on hard surfaces   |  |\n| Symptoms   | ·Pain at plantar aspect of heel &hindfoot  \u003Cbr>·Worse with weight bearing(especially after prolonged rest)   |  |\n| Diagnosis   | ·Tenderness at insertion of plantar fascia  \u003Cbr>·Pain with dorsiflexion of toes  \u003Cbr>·Presence of heel spurs on x-ray has low sensitivity &specificity   |  |\n| Treatment   | ·Activity modification  \u003Cbr>·Stretching exercises  \u003Cbr>·Heel pads/orthotics   |  |\n\nThis patient with heel pain that is worse with weight bearing has plantar fasciitis.The plantar aponeurosis (deep plantar fascia)is a fibrousband that extends from the calcaneus to the toes and supports the longitudinal arch of the foot.Plantar fasciitis is characterized by inflammationand degeneration of the aponeurosis due to overuse and repetitive stress.It is common in middle-aged adults,especially those who are obeseThe pain is typically worst during the first steps of the day but gets better during the day(eg,does not recur with normal activity);the pain alsoworsens after long periods of standing or walking.  \nExamination in plantar fasciitis shows tenderness at the insertion of the plantar fascia on the calcaneus,which is worse during passivedorsiflexion of the toes.Initial management includes activity modification (eg,avoiding walking barefoot),stretching,and padded heel inserts.Symptoms may take months to completely resolve.  \n(Choice A)Calcaneal stress fractures can occur after initiation of a high-impact exercise program.They cause heel pain with weight bearing,butthe pain is elicited by pressure at the sides of the heel (calcaneal squeeze test)rather than at the insertion of the plantar fascia.  \n(Choice B)Charcot joint (neurogenic arthropathy)presents with deformity and sensory deficits of the foot.Because it relates to recurrent traumadue to impaired proprioception and pain sensation,the pain is typically mild.  \n(Choice C)X-ray in patients with plantar fasciitis may show calcifications in the proximal fascia (heel spurs),but this is neither sensitive norspecific.Heel spurs are a late sign of inflammation and degeneration in the proximal plantar fascia but are not the cause of pain.  \n(Choice D)Morton (interdigital)neuroma is mechanically induced neuropathic degeneration of the interdigital nerves.It presents with numbness  \nTreatment  \nThis patient with heel pain that is worse with weigband that extends from the calcaneus to the toes aland degeneration of the aponeurosis due to overusThe pain","cbCaifW8raP9cNtF","https://ap.wps.com/l/cbCaifW8raP9cNtF","pdf",43305176,149,"English","# Educational objective\n## Presenting symptoms and exam findings\n## Diagnosis and role of heel spurs\n## Differential diagnosis\n## Treatment approach","[{\"question\":\"What clinical findings most strongly suggest plantar fasciitis in this case?\",\"answer\":\"Pain on the sole that is worse with prolonged weight bearing, tenderness at the insertion of the plantar fascia on the calcaneus, and pain reproducible with dorsiflexion of the toes.\"},{\"question\":\"Why are heel spurs on x-ray not the cause of plantar fasciitis pain?\",\"answer\":\"Heel spurs are a late sign of inflammation and degeneration in the proximal plantar fascia and have low sensitivity and specificity; they are not the direct pain generator.\"},{\"question\":\"What are the initial management steps for plantar fasciitis?\",\"answer\":\"Activity modification, stretching exercises, and padded heel inserts/orthotics are recommended first, and symptom resolution may take months.\"}]","Plantar Fasciitis - Heel Pain Question and Explanation | PDF",1791593220,375]