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Treatment of Plantar Fasciitis - Article
ABSTRACT: Plantar fasciitis is a common cause of heel pain in adults. The disorder classically presents with pain that is particularly severe with the first few steps taken in the morning. In general, plantar fasciitis is a self-limited condition. However, symptoms usually resolve more quickly when the interval between the onset of symptoms and the onset of treatment is shorter. Many treatment options exist, including rest, stretching, strengthening, change of shoes, arch supports, orthotics, night splints, anti-inflammatory agents and surgery. Usually, plantar fasciitis can be treated successfully by tailoring treatment to an individual's risk factors and preferences.
Over-the-Counter Foot Remedies - Article
ABSTRACT: Several effective and inexpensive over-the-counter treatments are available for minor but troubling foot problems. In most cases, one week of therapy with topical terbinafine is effective for interdigital tinea pedis. Treatment of plantar warts with 17 percent salicylic acid with lactic acid in a collodion base is as effective as cryotherapy, but treatment must be sustained for several months. Toe sleeves and toe spacers can relieve pain from hard or soft corns. Metatarsal pads can relieve the pressure associated with plantar keratoses. Heel cups often can relieve pain caused by age-related thinning of the heel fat pad. Plantar fasciitis is a common cause of anteromedial heel pain caused by repetitive strain on the plantar fascia. Although the mainstay of therapy is stretching exercises, ready-made arch supports and insoles can be helpful adjuncts.
ABSTRACT: The formation of corns and calluses can be caused by mechanical stresses from faulty footgear (the wearing of poorly fitting shoes), abnormal foot mechanics (deformity of the foot exerting abnormal pressure), and high levels of activity. Corns and calluses result from hyperkeratosis, a normal physiologic response of the skin to chronic excessive pressure or friction. Treatment should provide symptomatic relief and alleviate the underlying mechanical cause. The lesions will usually disappear following the removal of the causative mechanical forces. Most lesions can be managed conservatively by the use of properly fitting shoes and padding to redistribute mechanical forces. Surgery is only indicated if conservative measures fail and should be aimed at correcting the abnormal mechanical stresses.
ABSTRACT: Joint and soft tissue injection of the ankle and foot region is a useful diagnostic and therapeutic tool for the family physician. This article reviews the injection procedure for the plantar fascia, ankle joint, tarsal tunnel, interdigital space, and first metatarsophalangeal joint. Indications for plantar fascia injection include degeneration secondary to repetitive use and traumatic injuries that are unresponsive to conservative treatment. Diagnostic aspiration or therapeutic injection of the ankle or first metatarsophalangeal joints can be performed for management of advanced osteoarthritis, rheumatoid arthritis, and other inflammatory arthritides such as gout, or synovitis or an arthrosis such as "turf toe." Persistent pain and disability resulting from tarsal tunnel syndrome, an analog of carpal tunnel syndrome of the wrist respond to local injection therapy. A painful interdigital space, such as that occurring in patients with Morton's neuroma, is commonly relieved with corticosteroid injection. The proper technique, choice and quantity of pharmaceuticals, and appropriate follow-up are essential for effective outcomes.
ABSTRACT: Chronic foot pain is a common and often disabling clinical complaint that can interfere with a patient's routine activities. Despite careful and detailed clinical history and physical examination, providing an accurate diagnosis is often difficult because chronic foot pain has a broad spectrum of potential causes. Therefore, imaging studies play a key role in diagnosis and management. Initial assessment is typically done by plain radiography; however, magnetic resonance imaging has superior soft-tissue contrast resolution and multiplanar capability, which makes it important in the early diagnosis of ambiguous or clinically equivocal cases when initial radiographic findings are inconclusive. Computed tomography displays bony detail in stress fractures, as well as in arthritides and tarsal coalition. Bone scanning and ultrasonography also are useful tools for diagnosing specific conditions that produce chronic foot pain.
ABSTRACT: The most common cause of heel pain is plantar fasciitis. It is usually caused by a biomechanical imbalance resulting in tension along the plantar fascia. The diagnosis is typically based on the history and the finding of localized tenderness. Treatment consists of medial arch support, anti-inflammatory medications, ice massage and stretching. Corticosteroid injections and casting may also be tried. Surgical fasciotomy should be reserved for use in patients in whom conservative measures have failed despite correction of biomechanical abnormalities. Heel pain may also have a neurologic, traumatic or systemic origin.
Charcot Foot: The Diagnostic Dilemma - Article
ABSTRACT: Primary care physicians involved in the management of patients with diabetes are likely to encounter the diagnostic and treatment challenges of pedal neuropathic joint disease, also known as Charcot foot. The acute Charcot foot is characterized by erythema, edema and elevated temperature of the foot that can clinically mimic cellulitis or gout. Plain film radiographic findings can be normal in the acute phase of Charcot foot. A diagnosis of Charcot syndrome should be considered in any neuropathic patient, even those with a minor increase of heat and swelling of the foot or ankle, especially after any injury. Early recognition of Charcot syndrome and immobilization (often with a total contact cast), even in the presence of normal radiographs, can minimize potential foot deformity, ulceration and loss of function. Orthopedic or podiatric foot and ankle specialists should be consulted when the disease process does not respond to treatment.
Custom vs. Prefabricated Orthoses for Foot Pain - Cochrane for Clinicians
ABSTRACT: Compared with placebo or sham, custom-made foot orthoses modestly reduce foot pain from pes cavus (high arch), arthritis, plantar fasciitis, and painful hallux valgus. However, there is no evidence that custom orthoses are more effective than prefabricated ones.
American College of Foot and Ankle Surgeons: Diagnosis and Treatment of Heel Pain - Practice Guidelines
Foot Bumps: Now You See Them, Now You Don't - Photo Quiz