eMedicine Specialties > Physical Medicine and Rehabilitation > Lower Limb Musculoskeletal Conditions

Plantar Fasciitis: Follow-up

Author: Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Coauthor(s): Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Contributor Information and Disclosures

Updated: Mar 31, 2008

Follow-up

Further Outpatient Care

  • The patient should return for a re-evaluation no more than approximately 1 month after initial evaluation and implementation of a rehabilitation program.
  • Patients requiring more aggressive treatment due to severe disruption of their athletic, occupational, or recreational activities may need to be seen more frequently, mainly for re-assurance and to chart progress with therapeutic interventions.
  • At the time of follow-up, assess the therapeutic response to the corticosteroid injection and evaluate for any complications.
  • The patient should be instructed to contact the physician before the scheduled follow-up appointment if there is significant progression of the symptoms or if there are any local signs of infection at the injection site.

Deterrence

  • Education is the single most important means of deterrence and prevention of plantar fasciitis. Sports -minded patients (especially runners) should be advised on the appropriateness of their shoes. Padding, sole stiffness, and appropriate arch support all can help to alleviate symptoms. The patient may need to decrease his/her running temporarily and resume at the discretion of the physician and physical therapist. In cases of occupationally related plantar fasciitis, evaluation of the worker's shoes and work environment is essential to preventing a recurrence of this musculoskeletal condition.

Complications

  • Please see Medical Issues/Complications for a discussion of complications, such as plantar fat pad atrophy secondary to corticosteroid injection.

Prognosis

  • Most patients with plantar fasciitis are treated successfully with aggressive nonsurgical treatment.

Patient Education

  • The patient should understand proper performance of a home exercise program involving stretching the plantar fascia.
  • The patient should be educated to watch for any signs or symptoms of local infection at the injection site, while maintaining good skin hygiene.
  • Diabetic patients should be informed that they may experience a transient increase in blood glucose levels and should be instructed to monitor their blood sugar carefully for the week following the corticosteroid injection.
  • Patients should be informed that the symptomatic improvement from the corticosteroid usually does not begin to take effect until a few days after the injection. They may experience a transient, mild increase in symptoms when the effect of the short-term local anesthetic has ended but the long-term corticosteroid effect has not yet begun.

Miscellaneous

Medicolegal Pitfalls

  • Improper placement of a corticosteroid injection for plantar fasciitis can result in necrosis and atrophy of the plantar fat pad at the heel. This complication may result in significant pain and a decreased activity level for the patient.

Special Concerns

  • Pregnancy - Corticosteroid injection can be performed during pregnancy, although safety for use during pregnancy has not been established. Oral NSAIDs should be avoided during pregnancy.
  • Pediatric population - Obtain informed consent from the parent or legal guardian before proceeding with examination or any injection.
  • Geriatric patients - Use NSAIDs with caution in elderly patients, monitoring for the most common adverse effects and for any drug interactions.
  • Diabetes - Some patients with diabetes may experience a transient elevation in blood glucose levels after corticosteroid injection.
 
Acknowledgments

Debra Ibrahim, 4th year medical student, New York College of Osteopathic Medicine, Class of 2008, assisted with the 2007 revision of this manuscript.



More on Plantar Fasciitis

Overview: Plantar Fasciitis
Differential Diagnoses & Workup: Plantar Fasciitis
Treatment & Medication: Plantar Fasciitis
Follow-up: Plantar Fasciitis
References
[ CLOSE WINDOW ]

References

  1. Brinker MR, Miller MD. Common adult conditions of the foot. In: Fundamentals of Orthopaedics. Philadelphia, Pa: WB Saunders; 1999:349-58.

  2. McGee DJ. Lower leg, ankle and foot. In: Orthopedic Physical Assessment. 2nd ed. Philadelphia, Pa: WB Saunders; 1992:448-513.

  3. Snider RK. Plantar fasciitis. In: Snider RK, ed. Essentials of Musculoskeletal Care. Rosemont, Ill: American Academy of Orthopaedic Surgeons; 1997:464-9.

  4. Tarquinio TA. Foot. In: Steinberg GG, Akins CM, Baran DT, eds. Orthopaedics in Primary Care. 3rd ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 1999:268-96.

  5. Young JL, Olsen NK, Press JM. Musculoskeletal disorders of the lower limbs. In: Braddom RL, ed. Physical Medicine and Rehabilitation. Philadelphia, Pa: WB Saunders; 1996:783-812.

  6. Lennard TA. Fundamentals of procedural care. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:1-13.

  7. Cole C, Seto C, Gazewood J. Plantar fasciitis: evidence-based review of diagnosis and therapy. Am Fam Physician. Dec 1 2005;72(11):2237-42. [Medline]. [Full Text].

  8. Hsu CC, Tsai WC, Chen CP, et al. Ultrasonographic examination of the normal and injured posterior cruciate ligament. J Clin Ultrasound. Jul-Aug 2005;33(6):277-82. [Medline].

  9. Radford JA, Landorf KB, Buchbinder R, et al. Effectiveness of calf muscle stretching for the short-term treatment of plantar heel pain: a randomised trial. BMC Musculoskelet Disord. Apr 19 2007;8:36. [Medline]. [Full Text].

  10. Flanigan RM, Nawoczenski DA, Chen L, et al. The influence of foot position on stretching of the plantar fascia. Foot Ankle Int. Jul 2007;28(7):815-22. [Medline].

  11. Bazaz R, Ferkel RD. Results of endoscopic plantar fascia release. Foot Ankle Int. May 2007;28(5):549-56. [Medline].

  12. Geiringer SR. Tendon sheath and insertion injections. In: Lennard TA, ed. Physiatric Procedures in Clinical Practice. Philadelphia, Pa: Hanley & Belfus; 1995:44-8.

  13. Lee TG, Ahmad TS. Intralesional autologous blood injection compared to corticosteroid injection for treatment of chronic plantar fasciitis. A prospective, randomized, controlled trial. Foot Ankle Int. Sep 2007;28(9):984-90. [Medline].

  14. Porter MD, Shadbolt B. Intralesional corticosteroid injection versus extracorporeal shock wave therapy for plantar fasciopathy. Clin J Sport Med. May 2005;15(3):119-24. [Medline].

  15. Govindarajan R, Bakalova T, Doss NW, et al. Posterior tibial nerve block in the therapeutic management of painful calcaneal spur (plantar fasciitis): a preliminary experience. Can J Anaesth. Oct 2003;50(8):862-3. [Medline]. [Full Text].

  16. Kane D, Greaney T, Bresnihan B, et al. Ultrasound guided injection of recalcitrant plantar fasciitis. Ann Rheum Dis. Jun 1998;57(6):383-4. [Medline]. [Full Text].

  17. Tsai WC, Wang CL, Tang FT, et al. Treatment of proximal plantar fasciitis with ultrasound-guided steroid injection. Arch Phys Med Rehabil. Oct 2000;81(10):1416-21. [Medline].

  18. Ogden JA, Alvarez RG, Marlow M. Shockwave therapy for chronic proximal plantar fasciitis: a meta-analysis. Foot Ankle Int. Apr 2002;23(4):301-8. [Medline].

  19. Babcock MS, Foster L, Pasquina P, et al. Treatment of pain attributed to plantar fasciitis with botulinum toxin A: a short-term, randomized, placebo-controlled, double-blind study. Am J Phys Med Rehabil. Sep 2005;84(9):649-54. [Medline].

  20. Allen BH, Fallat LM, Schwartz SM. Cryosurgery: an innovative technique for the treatment of plantar fasciitis. J Foot Ankle Surg. Mar-Apr 2007;46(2):75-9. [Medline].

[ CLOSE WINDOW ]

Further Reading

[ CLOSE WINDOW ]

Keywords

heel pain syndrome, plantar heel pain, proximal plantar fasciitis, subcalcaneal pain, orthotic arch support, shoe insert, heel pad, fat pad, heel spur, exostosis

[ CLOSE WINDOW ]

Contributor Information and Disclosures

Author

Patrick M Foye, MD, FAAPMR, FAAEM, Associate Professor of Physical Medicine and Rehabilitation, Co-Director of Musculoskeletal Fellowship, Co-Director of Back Pain Clinic, Director of Coccyx Pain (Tailbone Pain, Coccydynia) Service, University of Medicine and Dentistry of New Jersey, New Jersey Medical School
Patrick M Foye, MD, FAAPMR, FAAEM is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, Association of Academic Physiatrists, and International Spine Intervention Society
Disclosure: Nothing to disclose.

Coauthor(s)

Todd P Stitik, MD, Professor, Department of Physical Medicine and Rehabilitation, Acting Director of Sports Medicine, UMDNJ-New Jersey School of Medicine; Lead Physician, Practice Medical Director of University Hospital PM & R Clinic
Todd P Stitik, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, Association of Academic Physiatrists, Phi Beta Kappa, and Physiatric Association of Spine, Sports and Occupational Rehabilitation
Disclosure: Nothing to disclose.

Medical Editor

Everett C Hills, MD, MS, Medical Director, Penn State Hershey Rehabilitation Hospital, Assistant Professor of Orthopaedics and Rehabilitation, Assistant Professor of Neurology, Penn State Milton S. Hershey Medical Center and Penn State University College of Medicine
Everett C Hills, MD, MS is a member of the following medical societies: American Academy of Disability Evaluating Physicians, American Academy of Physical Medicine and Rehabilitation, American College of Physician Executives, American Congress of Rehabilitation Medicine, American Medical Association, American Society of Neurorehabilitation, Association of Academic Physiatrists, and Pennsylvania Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

Francisco Talavera, PharmD, PhD, Senior Pharmacy Editor, eMedicine
Disclosure: Nothing to disclose.

Managing Editor

Michael T Andary, MD, MS, Residency Program Director, Professor, Department of Physical Medicine and Rehabilitation, Michigan State University College of Osteopathic Medicine
Michael T Andary, MD, MS is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation, American Association of Neuromuscular and Electrodiagnostic Medicine, American Medical Association, and Association of Academic Physiatrists
Disclosure: Nothing to disclose.

CME Editor

Kelly L Allen, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Lourdes Regional Rehabilitation Center, Our Lady of Lourdes Medical Center
Disclosure: Nothing to disclose.

Chief Editor

Consuelo T Lorenzo, MD, Consulting Staff, Department of Physical Medicine and Rehabilitation, Alegent Health Care, Immanuel Rehabilitation Center
Consuelo T Lorenzo, MD is a member of the following medical societies: American Academy of Physical Medicine and Rehabilitation
Disclosure: Nothing to disclose.

 
 
HONcode

We subscribe to the
HONcode principles of the
Health On the Net Foundation

All material on this website is protected by copyright, Copyright© 1994- by Medscape.
This website also contains material copyrighted by 3rd parties.

DISCLAIMER: The content of this Website is not influenced by sponsors. The site is designed primarily for use by qualified physicians and other medical professionals. The information contained herein should NOT be used as a substitute for the advice of an appropriately qualified and licensed physician or other health care provider. The information provided here is for educational and informational purposes only. In no way should it be considered as offering medical advice. Please check with a physician if you suspect you are ill.