There is good research supporting shockwave therapy for the treatment of PF – in fact, it is considered superior to cortisone injections. Although it may be slow to resolve, a conservative approach is the treatment of choice and fairly straightforward: improve the compliance of the plantar fascia (local modalities, stretches), release the tension within the posterior fascial subsystem (IASTM, modalities, myofascial release), balance the pathomechanics within the kinetic chain (CMT from the foot to the cervical spine as indicated), and strengthen both the intrinsic and extrinsic foot muscles.Ĭlinical Tip: Currently, the term plantar fasciopathy, PF, is a more accurate term versus plantar fasciitis to describe this condition. Plantar fasciopathy, PF, is a degenerative condition related to overuse and microtears within the plantar fascia and was the initial diagnosis. ![]() A comparative view of the right calcaneus was taken which indicated an identical spur therefore, the presence of the heel spur was considered to be clinically insignificant. Radiographs of the left calcaneus were taken to rule out osseous pathology and demonstrated a small heel spur along the anterior-inferior aspect of the calcaneus. When the tenderness increases under load, it indicates the plantar fascia is the potential pain driver. In addition, the left acetabulum had reduced joint play in internal rotation and extension, and spinal pathomechanics were present at L5-S1 and the left sacroiliac joint.Ĭlinical Tip: In palpating the plantar fascia, initially palpate it with the foot relaxed and then re-palpate the tissues with the toes extended, which places the plantar fascia under load. Restricted joint play was noted in AP glide of the talus, calcaneal eversion, AP glide of the talonavicular joint, and AP glide of the cuboid and cuneiforms on the metatarsals. Orthopedic testing was positive for low back pain with Kemp’s on the left. Tenderness to palpation was found over the plantar aspect and along the lateral aspect of the calcaneus, as well as over the soleus, gastrocnemius, gluteus medius, and iliolumbar ligament on the left. There was no evidence of navicular drift. His navicular drop test measured 5 mm on the right and 7 mm on the left. Taking Co-Q 10 will lessen the MSK side effects.Įxamination revealed no nerve-root compression or traction signs, as DTRs, sensation and motor strength tests of the upper and lower extremity were WNL. Have patients taking statins discuss a two- to four-week trial of abstinence with their PCP to determine if their MSK pain is related to a statin side effect. Therefore, it must always be considered a potential causative agent when patients present with MSK pain. Medications include losartan for hypertension, Lipitor for cholesterol management and a prescription B-complex.Ĭlinical Tip: The side effects of statins include musculoskeletal manifestations including tendinopathy of the rotator cuff and hand (trigger finger). For work, he wears dress loafers with a thin rubber sole. In addition, he walks 20 minutes from the train station to his office every day. He walks for exercise on the treadmill 2x/week at a brisk pace, with hand weights and 5 degrees elevation. ![]() He felt that his shoes “pinch” and are not fitting correctly anymore. It began insidiously, was worse upon awakening in the morning and loosened up during the day. Sam is a 60-year-old male standing 6’1” and weighing 195 lbs, who presented with pain on the bottom of his left foot and heel that had been persistent for 4-5 weeks. Let’s look at an interesting case of heel pain and how it responded to a multimodal approach to care. Heel pain, worse in the morning when arising, after sitting a long time, and often loosens up after walking a bit – sounds like plantar fasciitis, right? Maybe.
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