eMedicine Specialties > Sports Medicine > Foot and Ankle

Plantar Fasciitis

Updated: Jan 18, 2008

Introduction

Background

Plantar fasciitis is the pain caused by inflammation of the insertion of the plantar fascia on the medial process of the calcaneal tuberosity. Plantar fasciitis may cause significant heel pain, resulting in the alteration of a person's activities. This condition sometimes is called "heel spurs" by the general public. In actuality, many asymptomatic individuals have bony heel spurs, whereas many patients with plantar fasciitis have no bony heel spur.¹

For excellent patient education resources, visit eMedicine's Sports Injury Center and Foot, Ankle, Knee, and Hip Center. Also, see eMedicine's patient education articles Running, Arch Pain, and Ankylosing Spondylitis, Neurologic Perspective.

Related eMedicine topics:
Plantar Fasciitis [in the Physical Medicine and Rehabilitation section]
Plantar Fasciitis [in the Emergency Medicine section]
Plantar Fasciitis [in the Orthopedic Surgery section]

Frequency

United States

A survey of professional football, baseball, and basketball team physicians and trainers found that plantar fasciitis was among the 5 most common foot and ankle injuries observed in professional athletes.² It is estimated that approximately 1 million patient visits per year are due to plantar fasciitis.³

Functional Anatomy

The plantar fascia is a thickened fibrous aponeurosis that originates from the medial tubercle of the calcaneus, runs forward to insert into the deep, short transverse ligaments of the metatarsal heads, and continues forward to form the fibrous flexor sheathes on the plantar aspect of the toes. The central plantar fascia is the thickest and strongest section, and this segment is also the most likely to be involved with plantar fasciitis. The function of the plantar fascia is to provide static support for the longitudinal arch of the foot and to assist with shock absorption during foot strike.

Sport-Specific Biomechanics

During running, the vertical forces in the foot at foot strike may reach 2-3 times an individual's body weight.⁴ The plantar fascia and longitudinal arch are also part of the foot's shock absorption mechanism.

The plantar fascia acts as a windlass mechanism during running (see Clinical, Physical, below). During the heel-off phase of gait, tension increases on the plantar fascia, which acts as a storage of potential energy. During toe-off, the plantar fascia passively contracts, converting the potential energy into kinetic energy and imparting greater foot acceleration.

Clinical

History

Pain
- The sine qua non of plantar fasciitis is a history of intense sharp heel pain with the first couple of steps in the morning.⁵ Pain is experienced primarily at the anterior aspect of the calcaneus, but it may radiate proximally in more severe cases. The athlete may complain of a dull ache in the heel at the end of the day, especially after extensive walking or standing.
- During activity, the pain usually decreases as the athlete warms up, but it generally returns after activity. The pain is aggravated particularly by sprinting. In more severe cases, the athlete complains of heel pain after periods of prolonged sitting.
Associated symptoms: In addition to pain, athletes may complain of stiffness in the foot and of localized swelling in the heel.

Physical

Palpation over the medial tubercle of the calcaneus usually reproduces the pain of plantar fasciitis. In more severe cases, pain may also be reproduced by palpation over the proximal portion of the plantar fascia. Other maneuvers that may reproduce the pain of plantar fasciitis include passive dorsiflexion of the toes, which is sometimes called a "windlass" test, or having the athlete stand on the tiptoes and toe-walk. In a study by De Garceau et al, having the patient bear weight during the windlass test (see Image 1) increased the sensitivity of the test from 13.6% to 31.8%.⁶

Related eMedicine topics:
Calcaneus, Fractures
Fractures, Foot

Causes

Extrinsic risk factors
- Training errors
  - Training errors are among the major causes of plantar fasciitis.
  - Athletes usually have a history of an increase in distance, intensity, or duration of activity.
  - The addition of speed workouts, plyometrics, and hill workouts are particularly high-risk behaviors for the development of plantar fasciitis.
  - Running indoors on poorly cushioned surfaces is also a risk factor.
- Equipment
  - Athletes should wear an appropriate shoe type for their foot type and activity (see Treatment, Acute Phase, Other Treatment, below).
  - Athletic shoes rapidly lose cushioning properties.⁷ Athletes who use shoe-sole repair materials are especially at risk if they do not change shoes often.
  - Athletes who train in lightweight and minimally cushioned shoes (instead of heavier training flats) are also at higher risk of developing plantar fasciitis.
Intrinsic risk factors
- Structural risk factors
  - Structural risk factors include pes planus, overpronation, pes cavus, leg-length discrepancy, excessive lateral tibial torsion, and excessive femoral anteversion.
  - Athletes with pes planus (low-arched) or pes cavus (high-arched) feet have increased stress placed on the plantar fascia with foot strike.⁷
  - Pronation is a normal motion during walking and running, providing foot-to-ground surface accommodation and impact absorption by allowing the foot to unlock and become a flexible structure. Overpronation, on the other hand, can lead to increased tension on the plantar fascia.
  - Leg-length discrepancy, excessive lateral tibial torsion, and excessive femoral anteversion can lead to an alteration of running biomechanics, which may increase plantar fascia stress.
- Functional risk factors
  - Tightness in the gastrocnemius and soleus muscles and the Achilles tendon is considered a risk factor for plantar fasciitis. Reduced dorsiflexion has been shown to be an important risk factor for this condition.³
  - Weakness of the gastrocnemius, soleus, and intrinsic foot muscles is also considered a risk factor for plantar fasciitis.
- Degenerative risk factors
  - Aging and heel fat pad atrophy are 2 degenerative risk factors for plantar fasciitis.

Related eMedicine topics:
Pes Cavus
Pes Planus
Tibial Bowing

Differential Diagnoses

Contusions
Lumbosacral Radiculopathy

Workup

Laboratory Studies

Usually, laboratory studies are not needed in the workup of plantar fasciitis.

Imaging Studies

Usually, radiographs are not necessary for the physician to diagnose plantar fasciitis. However, to rule out a bony tumor or fracture, always consider obtaining at least a plain radiograph before administering a corticosteroid injection.
- A heel spur is found in 15-25% of asymptomatic individuals in the general population; however, many patients with plantar fasciitis have no heel spur.
Reserve magnetic resonance imaging (MRI) or diagnostic ultrasound for the rare cases in which imaging studies are needed to confirm plantar fasciitis or partial and complete plantar fascia rupture.
Bone scans are useful to evaluate for stress fractures, tumors, and infection.

Other Tests

Electromyographic (EMG) studies are useful to evaluate for possible neurologic entrapment syndromes.

Procedures

Usually, no special procedures are needed for plantar fasciitis.

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

The initial physical therapy program for plantar fasciitis emphasizes stretching of the calf and foot. The stretching program should include wall stretches, with the knee in both the extended and flexed positions.

To perform a wall stretch, the athlete should stand 3 feet from a wall, placing the hands on the wall. Keeping the toes pointed straight and the heel on the ground, the athlete leans the hips toward the wall, then holds this position for 30-40 seconds (see Image 2).⁵ Stretches targeted at the plantar fascia are particularly important.⁸
In one study, iontophoresis was found to increase the speed of resolution of plantar fasciitis, although it had no effect on long-term outcome.⁹

Medical Issues/Complications

Ice is the first-line anti-inflammatory treatment for plantar fasciitis. Icing should be performed after completing exercise, stretching, and strengthening, and this treatment can be applied by ice massage, ice bath, or ice pack.

For ice massage, the athlete freezes water in a small paper or polystyrene cup and then rubs the ice over the painful heel, using a circular motion and moderate pressure for 5-10 minutes.

For an ice bath, a shallow pad is filled with water and ice. The athlete soaks the heel for 10-15 minutes. Note: To prevent cold injuries, the athlete should use neoprene toe covers, or keep the toes out of the ice water.

An ice pack can be made by placing crushed ice in a plastic bag that is wrapped in a towel. The use of crushed ice allows the ice pack to be molded to the foot and increases the contact area; a good alternative is a bag of prepackaged frozen corn kernels wrapped in a towel. Ice packs are usually placed for 15-20 minutes.

Other Treatment

Resting and correcting training errors are critical to the treatment of plantar fasciitis. Athletes must modify activities that aggravate this condition; such modifications may be as simple as decreasing the amount, frequency, or intensity of the inciting activity(ies). Athletes are more compliant with a decreased level of activity if they are allowed to increase other nonaggravating activities.¹⁰

Replacing worn-out shoes and selecting appropriate shoes are also important. Runners should replace shoes every 250-500 miles (400-800 km) to maintain optimum shoe cushioning.⁷

Runners who overpronate and who have pes planus should select motion-control shoes, which typically feature a straight-lasted, board-lasted, or combination-lasted construction; an external heel counter; a wider flare; and extra medial support.⁷

Runners who have pes cavus should select shoes that have greater cushioning properties.

All distance runners should practice in training flats that are better cushioned, reserving the lighter weight, less-cushioned racing flats for competition.

Extracorporeal shock wave therapy (ESWT) has been proposed as a treatment option for plantar fasciitis. There appears to be few, if any, adverse side effects from this treatment modality. However, to date, results from studies are mixed.^{11,12,13,14,15,16,17}

Recovery Phase

Rehabilitation Program

Physical Therapy

A strengthening program that emphasizes intrinsic foot muscle strengthening is added in the next phase of physical therapy. Exercises include towel curls, marble pick-ups, and toe taps.⁵

For a towel curl, the athlete sits with the affected foot lying flat on the end of a towel that is placed on a smooth surface. The athlete pulls the towel toward the body by using the toes to curl up the towel while keeping the heel on the floor. As the athlete improves, add weight to the far end of the towel to increase the difficulty of this exercise (see Image 3).
To do marble pick-ups, the athlete places a few marbles on the floor near a cup, picks them up with the toes, and drops them in the cup while keeping the heel on the floor. For a greater challenge, the athlete may try to pick up coins instead of marbles.
To do toe taps, the athlete lifts all the toes off the floor; while keeping the heel on the floor and the outside 4 toes in the air, repetitively taps just the big toe to the floor (see Image 4). Next, the athlete reverses the process and repetitively taps the outside 4 toes to the floor while keeping the big toe in the air.

Medical Issues/Complications

Anti-inflammatory medications are frequently used to treat plantar fasciitis. Although there is controversy as to whether or not nonsteroidal anti-inflammatory drugs (NSAIDs) actually assist in the physiologic healing process, these agents can be useful as an adjunct to control pain while the individual's plantar fasciitis is being treated with stretching, strengthening, and relative rest (see the Medication section, below).^18,19

Surgical Intervention

For cases that do not respond to conservative treatment, a surgical release of the plantar fascia may be considered. Overall, surgical release has a 70-90% success rate in treating patients with this condition; open, endoscopic, or radiofrequency lesioning techniques may be used.^{20,21,22,23,24,25,26}

Potential complications of surgical intervention include flattening of the longitudinal arch and heel hypoesthesia, as well as those that are associated with plantar fascia rupture and corticosteroid injections. Longitudinal arch strain appears to account for over 50% of the chronic complications.^27,28

Other Treatment (Injection, manipulation, etc.)

Corticosteroid injections

In cases of recalcitrant plantar fasciitis, corticosteroid injection may be considered. Other causes of heel pain should also be considered, and a plain radiograph of the foot or calcaneus should always be obtained before injecting steroids.
A corticosteroid injection may be given through a plantar or a medial approach, with or without ultrasound guidance. Studies have reported success rates of 70% or better.^29,30 Potential risks include plantar fascia rupture, which was found in almost 10% of patients after plantar fascia injection in one case series²⁷ and fat pad atrophy.^27,28 Long-term sequelae were found in approximately 50% the patients with plantar fascia rupture.²⁷

Autologous blood injections

The use of autologous blood injected into the plantar fascia origin is thought to stimulate an acute inflammatory reaction that leads to reinitiation of the healing process. This treatment has been shown to be effective in limited studies of chronic inflammatory musculotendinous conditions.^31,32,33

Night splints

Most people naturally sleep with their feet in a plantar-flexed position, which causes the plantar fascia to be shortened. Night splints are designed to keep the ankle in a neutral position during sleep, essentially passively stretching the calf and the plantar fascia for a prolonged period.
Theoretically, the night splint allows the plantar fascia to heal in the elongated position, which, in turn, decreases the tension on the fascia with the first step in the morning. A night splint can be molded from either plaster or fiberglass casting material, or a prefabricated and commercially produced plastic brace can be used (see Image 5).
Studies have shown that approximately 80% of patients using night splints had improvement of their plantar fasciitis.^{34,35,36,37,38} The splints are especially useful in individuals who have had symptoms of plantar fasciitis for longer than 12 months.^34,35,36,37

Maintenance Phase

Rehabilitation Program

Physical Therapy

To minimize the chances of reoccurrence of plantar fasciitis, athletes should continue on a maintenance program of daily stretching and/or strengthening at least 2-3 times per week.

Other Treatment

Other treatment may include orthotic devices and arch supports.

Patients with low arches place increased stress on the plantar fascia with foot strike and have a decreased ability to absorb the forces that are generated by foot strike.⁷ Mechanical corrections for pes planus include taping of the arches, over-the-counter (OTC) arch supports, and custom orthotic devices. Studies have found significant benefit to these conservative treatments when used in appropriate patients.^19,39
Arch taping can be used as a definitive treatment or as a trial to determine whether the expense of arch supports or orthotics is worthwhile for a patient. Taping may be more cost-effective for the acute onset of plantar fasciitis, whereas OTC arch supports and orthotics may be more cost-effective for chronic or recurrent cases of plantar fasciitis and for the prevention of injuries (the arches must be retaped for each practice or game).
OTC arch supports usually last a full season; custom orthotic devices should last many seasons. OTC arch supports are especially useful in athletes with acute plantar fasciitis and mild pes planus, particularly adolescents whose rapid foot growth may require one or more new pairs of arch supports per season.
Custom orthotic devices are designed to control biomechanical risk factors such as pes planus, valgus heel alignment, and leg-length discrepancies. Athletes treated with orthotic devices usually require semi-rigid, three-quarter to full-length orthotic devices with longitudinal arch support to control overpronation and metatarsal head motion, especially of the first metatarsal head.⁴⁰ The main disadvantage in the use of orthotic devices is the cost, which ranges from $75 to $300 or more; frequently, these devices are not covered by insurance.

Medication

The goals of pharmacotherapy are to reduce morbidity and prevent complications.

Nonsteroidal anti-inflammatory drugs

The use of NSAIDs in chronic inflammatory diseases such as plantar fasciitis is somewhat controversial.¹⁸ NSAIDs may or may not be beneficial to the physiologic processes of soft-tissue healing. However, NSAIDs have been found to be useful in controlling pain (a useful adjunct in allowing more rapid progress with physical therapy) and in controlling acute inflammation. The disadvantages of these medications are many, including the risk of gastrointestinal (GI) bleeding, gastric pain, and renal damage.⁴¹

Ibuprofen (Motrin, Ibuprin, Advil)

Member of the propionic acid group of NSAIDs. Available in low-dose form as an OTC medication. Highly protein bound, metabolized in the liver, and eliminated primarily in the urine. Ibuprofen may reversibly inhibit platelet function.

Dosing

Adult

600-800 mg PO tid/qid

Pediatric

Maximum 40 mg/kg PO divided tid/qid

Interactions

Coadministration with aspirin increases the risk of inducing serious NSAID-related side effects; probenecid may increase the concentrations and, possibly, the toxicity of NSAIDs; may decrease the effect of hydralazine, captopril, and beta-blockers; may decrease the diuretic effects of furosemide and thiazides; may increase PT duration when taking anticoagulants (instruct patients to watch for signs of bleeding); may increase the risk of methotrexate toxicity; phenytoin levels may be increased when administered concurrently

Contraindications

Documented hypersensitivity; patients with peptic ulcer disease, recent GI bleeding or perforation, renal insufficiency, or high risk of bleeding

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Caution in patients with congestive heart failure, hypertension, and decreased renal and hepatic function; caution in the presence of anticoagulation abnormalities or during anticoagulant therapy

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Member of the propionic acid group of NSAIDs. Available in low-dose form as an over-the-counter medication. Highly protein bound, metabolized in the liver, and eliminated primarily in the urine. Naproxen may reversibly inhibit platelet function.

Dosing

Adult

250-550 mg PO bid/tid; maximum 1100 mg when used for pain control and acute musculoskeletal injury; maximum daily dose is 1650 mg for all conditions

Pediatric

Maximum 10 mg/kg PO divided bid

Interactions

Contraindications

Documented hypersensitivity; peptic ulcer disease; recent GI bleeding or perforation; renal insufficiency

Precautions

Pregnancy

B - Fetal risk not confirmed in studies in humans but has been shown in some studies in animals

D - Fetal risk shown in humans; use only if benefits outweigh risk to fetus

Precautions

Acute renal insufficiency, interstitial nephritis, hyperkalemia, hyponatremia, and renal papillary necrosis may occur; patients with preexisting renal disease or compromised renal perfusion risk acute renal failure; leukopenia occurs rarely, is transient, and usually returns to normal during therapy; persistent leukopenia, granulocytopenia, or thrombocytopenia warrants further evaluation and may require discontinuation of the drug.

Corticosteroids

Corticosteroids are strong anti-inflammatory agents. The general risks involved with the use of these agents include skin atrophy, skin hypopigmentation, soft-tissue atrophy, infection, bleeding, and failure to work. A steroid flare-up, which consists of increased pain for up to several days, may occur in up to 2% of individuals who use corticosteroids.⁴²

Triamcinolone acetonide (Amcort)

Injectable corticosteroid, used to treat localized areas of inflammation. Good evidence exists to suggest that injected corticosteroids alter the long-term pathology of chronic inflammation^18,42; however, many patients receive acute symptomatic improvement.⁴² Triamcinolone acetonide is an injectable intermediate-acting, steroid anti-inflammatory agent.

Dosing

Adult

1 mL of 40 mg/mL solution injected into plantar fascia origin via central or lateral approach

Pediatric

Administer as in adults

Interactions

Local anesthetics containing the preservatives methylparaben, propylparaben, and phenol may cause flocculation of the steroid; corticosteroids may blunt antibody response in patients receiving immunizations concomitantly

Contraindications

Documented hypersensitivity; fungal, viral, and bacterial skin infections

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Injectable corticosteroids in pregnancy have not been studied; carefully monitor infants for hypoadrenalism when born to mothers who have received substantial exposure to corticosteroids; caution in patients with exposure to chicken pox, strongyloides infestation, active tuberculosis, ocular herpes simplex, psychiatric conditions, ulcerative colitis, diverticulitis, recent intestinal anastomoses, history of peptic ulcer disease, renal insufficiency, hypertension, osteoporosis, diabetes mellitus, thromboembolic disorders, seizures, hypoalbuminemia, hypothyroidism, cirrhosis, hyperlipidemias, glaucoma, cataracts and myasthenia gravis; caution in children, as growth and development may be affected by prolonged courses of corticosteroids, especially if given systemically

Betamethasone sodium (Celestone, Soluspan)

Injectable corticosteroid, used to treat localized areas of inflammation. No good evidence exists to suggest that injected corticosteroids alter the long-term pathology of chronic inflammation; however, many patients receive acute symptomatic improvement.⁴² Betamethasone sodium is an injectable intermediate-acting, steroid anti-inflammatory agent.

Dosing

Adult

Inject 0.5 mL of 6 mg/mL solution into plantar fascia origin via central or lateral approach

Pediatric

Administer as in adults

Interactions

Contraindications

Documented hypersensitivity; patients with fungal, viral, and bacterial skin infections

Precautions

Pregnancy

C - Fetal risk revealed in studies in animals but not established or not studied in humans; may use if benefits outweigh risk to fetus

Precautions

Injectable corticosteroids in pregnancy have not been studied; carefully monitor infants for hypoadrenalism when born to mothers who have received substantial exposure to corticosteroids; caution in patients with exposure to chicken pox, strongyloides infestation, active tuberculosis, ocular herpes simplex, psychiatric conditions, ulcerative colitis, diverticulitis, recent intestinal anastomoses, history of peptic ulcer disease, renal insufficiency, hypertension, osteoporosis, diabetes mellitus, thromboembolic disorders, seizures, hypoalbuminemia, hypothyroidism, cirrhosis, hyperlipidemias, glaucoma, cataracts, and myasthenia gravis; caution in children because growth and development may be affected by prolonged courses of corticosteroids, especially if given systemically

Follow-up

Return to Play

Athletes with plantar fasciitis may return to activities as limited by their symptoms. The physician might need to plan a strict activities regimen because many athletes tend to ignore pain during activity. Generally, athletes should start at 50% of their usual distance or time with a gradual increase of activity by approximately 10% per week.

Complications

In rare cases, the plantar fascia may rupture spontaneously. The risk of such a rupture is greatly increased by a history of treatment with a corticosteroid injection.²⁷

Long-term sequelae of rupture occur in approximately 50% of the patients who have a plantar fascia rupture.^27,28 Moreover, longitudinal arch strain accounts for over 50% of the chronic complications of plantar fascia rupture.^27,28

Prevention

Instruct athletes with plantar fasciitis to warm up sufficiently before initiating activity, continue stretching programs, and ice down after activity. Make sure that they wear appropriate shoes and change to a new pair every 250-500 miles (400-800 km).⁷ Alternating between 2 pairs of shoes seems to help some athletes by allowing the cushioning in the shoes to recover more completely between runs.

Prognosis

Plantar fasciitis can be a frustrating problem for many athletes because of its slow resolution; however, this condition is often resolved in most patients with conservative treatment.^19,43 Athletes should be cautioned not to expect overnight resolution, especially if they have more chronic pain or if they continue their activities.¹⁹

Education

Educate athletes about the importance of foot and calf strengthening and stretching, appropriate training volume and intensity, and appropriate shoe selection and rotation to decrease the risk of future injury.

Miscellaneous

Medicolegal Pitfalls

In cases of plantar fasciitis that do not have an adequate response to appropriate treatment, a plain radiograph is mandatory to ensure that a tumor or fracture has not been missed.

Multimedia

Media file 1: Weight-bearing windlass test.

Media file 2: Calf stretch.

Media file 3: Towel curl.

Media file 4: Toe taps.

Media file 5: Night splint.

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Keywords

heel spurs, heel pain, inflammation of the plantar fascia, calcaneal pain

Contributor Information and Disclosures

Author

Craig C Young, MD, Professor, Departments of Orthopedic Surgery and Community and Family Medicine, Medical Director of Sports Medicine, Sports Medicine Fellowship Director, Medical College of Wisconsin
Craig C Young, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Medical Society for Sports Medicine, Phi Beta Kappa, and Wilderness Medical Society
Disclosure: Nothing to disclose.

Medical Editor

Joseph P Garry, MD, Director of Sports Medicine and Sports Medicine Fellowship, Associate Professor of Family Medicine and Exercise and Sport Science, Department of Family Medicine, East Carolina University Brody School of Medicine
Joseph P Garry, MD is a member of the following medical societies: American Academy of Family Physicians, American College of Sports Medicine, American Heart Association, American Medical Society for Sports Medicine, North American Primary Care Research Group, and North Carolina Medical Society
Disclosure: Nothing to disclose.

Pharmacy Editor

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

Managing Editor

Russell D White, MD, Professor of Medicine, Department of Community and Family Medicine, University of Missouri-Kansas City School of Medicine, Truman Medical Center Lakewood
Disclosure: Nothing to disclose.

CME Editor

Jon B Whitehurst, MD, Clinical Instructor of Surgery, University of Illinois College of Medicine; Partner and Executive Board Member, Rockford Orthopedic Associates; Orthopedic Chairman, Rockford Memorial Hospital
Jon B Whitehurst, MD is a member of the following medical societies: American Academy of Orthopaedic Surgeons, American Orthopaedic Society for Sports Medicine, and Arthroscopy Association of North America
Disclosure: Nothing to disclose.

Chief Editor

Further Reading

eMedicine Specialties > Sports Medicine > Foot and Ankle

Plantar Fasciitis

Introduction

Background

Frequency

United States

Functional Anatomy

Sport-Specific Biomechanics

Clinical

History

Physical

Causes

Differential Diagnoses

Other Problems to Be Considered

Workup

Laboratory Studies

Imaging Studies

Other Tests

Procedures

Treatment

Acute Phase

Rehabilitation Program

Physical Therapy

Medical Issues/Complications

Other Treatment

Recovery Phase

Rehabilitation Program

Physical Therapy

Medical Issues/Complications

Surgical Intervention

Other Treatment (Injection, manipulation, etc.)

Maintenance Phase

Rehabilitation Program

Physical Therapy

Other Treatment

Medication

Nonsteroidal anti-inflammatory drugs

Ibuprofen (Motrin, Ibuprin, Advil)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Naproxen (Aleve, Anaprox, Naprosyn, Naprelan)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Corticosteroids

Triamcinolone acetonide (Amcort)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Betamethasone sodium (Celestone, Soluspan)

Dosing

Adult

Pediatric

Interactions

Contraindications

Precautions

Pregnancy

Precautions

Follow-up

Return to Play

Complications

Prevention

Prognosis

Education