ORTHOPEDICSPlantar Fasciitis
Plantar fasciitis is a common cause of plantar heel pain that occurs where the
plantar fascia arises from the medial calcaneal tuberosity. Inflammation in both
the bone and plantar fascia occurs from chronic degeneration in the fascia
fibers that arise from the bone.
SYMPTOMS/EXAM
■ Pain worse upon awakening or after prolonged rest
■ Pain localized to the heel or arch of the foot and, occasionally, over the
Achilles tendon
■ Flat feet
■ Point tenderness over the plantar medial calcaneal tuberosity (anterior
medial aspect of the calcaneus)
DIFFERENTIAL
Calcaneal stress fracture/tumor, fat pad atrophy, sciatica, tarsal tunnel syn-
drome, rupture of the plantar fascia
DIAGNOSIS
■ Clinical diagnosis (characteristic pain after rest and localized heel tenderness)
■ X-ray may reveal calcaneal spur.
TREATMENT
■ Heel pads
■ Arch supports
■ Night splints to stretch plantar fascia and hold the Achilles tendon to length
■ Achilles and plantar stretching exercises
■ Corticosteroid injection and surgery rarely needed
SOFT-TISSUE INFECTIONSFelon
Felon is infection of the fingertip pulp. The fingertip is separated into small
closed spaces by vertical septae. Infection can easily spread along these com-
partments and cause an abscess. S. aureusis the most common agent.
SYMPTOMS/EXAM
■ Swollen, tender fingertip, usually thumb or index finger
■ Fever
■ Previous finger trauma or splinter
DIAGNOSIS
■ Clinical diagnosis
■ X-ray if foreign body, fracture, or osteomyelitis suspected
TREATMENT
■ If early, warm soaks and antibiotics may be sufficient.
■ Incision and drainage are usually required with midlateral or midline longi-
tudinal incision through the fingerpad. Probe very gently with a blunt instru-
ment to avoid injury to nearby tendons and neurovascular bundle; loose
packing.