1/7. Use of the tissue stress model as a paradigm for developing an examination and management plan for a patient with plantar fasciitis. This case report demonstrates the use of the tissue stress model to develop an examination, evaluation, and management plan for a patient with an 8-week history of plantar fasciitis. The patient history focused on determining which tissues were being excessively stressed, and the physical examination was used to apply controlled stresses to these tissues and to determine factors contributing to the patient's condition. After it was confirmed that the patient's plantar fascia was under excessive mechanical stress, treatment first focused on reducing pain, inflammation, and stress on the plantar fascia and then on returning the patient to her running program while maintaining symptoms at a diminished level. The patient reported being free of pain 7 weeks after the initial physical therapy examination and at the 11-week telephone follow-up. Although no experimental evidence is given, this report suggests that this patient responded positively to treatment based on the tissue stress model. ( info) |
| fibrosarcoma is an uncommon, malignant soft-tissue tumor that is rarely found as a primary neoplasm in the foot. A case report is presented that demonstrates a large, locally invasive fibrosarcoma of the plantar aspect of the foot with initial symptoms consistent with plantar fasciitis. Below-the-knee amputation was performed as curative treatment. ( info) |
3/7. A combined treatment approach emphasizing impairment-based manual physical therapy for plantar heel pain: a case series. STUDY DESIGN: Case series. OBJECTIVE: To describe an impairment-based physical therapy treatment approach for 4 patients with plantar heel pain. BACKGROUND: There is limited evidence from clinical trials on which to base treatment decision making for plantar heel pain. methods AND MEASURES: Four patients completed a course of physical therapy based on an impairment-based model. All patients received manual physical therapy and stretching. Two patients were also treated with custom orthoses, and 1 patient received an additional strengthening program. Outcome measures included a numeric pain rating scale (NPRS) and self-reported functional status. RESULTS: Symptom duration ranged from 6 to 52 weeks (mean duration /-SD, 33 /-19 weeks). Treatment duration ranged from 8 to 49 days (mean duration /-SD, 23 /-18 days), with number of treatment sessions ranging from 2 to 7 (mode, 3). All 4 patients reported a decrease in NPRS scores from an average ( /-SD) of 5.8 /-2.2 to 0 (out of 10) during previously painful activities. Additionally, all patients returned to prior activity levels. CONCLUSION: In this case series, patients with plantar heel pain treated with an impairment-based physical therapy approach emphasizing manual therapy demonstrated complete pain relief and full return to activities. Further research is necessary to determine the effectiveness of impairment-based physical therapy interventions for patients with plantar heel pain/plantar fasciitis. ( info) |
4/7. Sterile abscess formation following a corticosteroid injection for the treatment of plantar fasciitis. A sterile abscess following a corticosteroid injection for the treatment of plantar fasciitis has not been reported in the literature. This case report demonstrates such a complication. A 45-year-old man presented with pain, erythemia, edema, and increased warmth to his left foot after 2 cortisone injections into his left heel over a 2-month period for plantar fasciitis. The symptoms began shortly after the second injection and after a 10-day course of oral antibiotics, the condition slowly worsened. A computerized axial tomography scan was suggestive of an abscess. Following incision and drainage, cultures that were taken during the surgical procedure did not produce any organism, prompting a diagnosis of a sterile abscess. The patient was discharged home and recovered from the abscess without reoccurrence or further surgical intervention. ( info) |
5/7. Lateral plantar nerve injury following steroid injection for plantar fasciitis. A 41 year old man presented with pain and numbness affecting the lateral aspect of his foot after a steroid injection for plantar fasciitis. Examination confirmed numbness and motor impairment of the lateral plantar nerve. The findings were confirmed by electromyographic studies. The anatomy of the lateral plantar nerve and correct technique for injection to treat plantar fasciitis are discussed. ( info) |
| Posterior uveitis is not a documented feature of Reiter's disease. We describe here a patient of Reiter's disease, who after a bout of dysentery in January 2002 developed macular edema of the right eye with visual acuity of 6/36. In December 2002, she was found to have phlyctenular conjunctivitis. In June 2004, when she reported with scaly plaques over both palms, repeat ophthalmological examination revealed macular degeneration of the right eye. The simultaneous occurrence of Reiter's disease and macular degeneration in this patient may be fortuitous but the immunological basis of both diseases suggests a possible association. ( info) |
7/7. Autologous blood injection and botulinum toxin for resistant plantar fasciitis accompanied by spasticity. An originally ambulatory 18-yr-old woman with spastic left hemiplegic cerebral palsy developed left plantar fasciitis with a gradual loss of function requiring use of a wheelchair. Her symptoms were resistant to physical therapy. Two hundred units of botulinum toxin A was diluted in 4 mL of saline and injected into the gastrocnemius. Three milliliters of autologous blood was injected into the plantar fascia. She reported decreased pain at 3 days postinjection. At 10 days, she had no pain on walking. Dorsiflexion increased and Ashworth and Tardieu improved. A stretching program was taught and a better-fitting night splint was obtained. At 21 days, she exhibited no pain and increased dorsiflexion. Autologous blood injection combined with botulinum toxin A may be an alternative treatment for resistant plantar fasciitis accompanied by spasticity. Our hypothesis is that chronic plantar fasciitis is a degenerative condition and thus is relieved when a mild inflammatory process is created that leads to healing. ( info) |