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Plantar fasciitis differential diagnosis?

Discussion in 'Biomechanics, Sports and Foot orthoses' started by podomania, Apr 3, 2011.

  1. podomania

    podomania Active Member


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    Hi all
    I had a patient yesterday who experiences tha typical sypmtoms of plantar fasciitis (pain when weightbearing, worst when waking up in the morning,minor pain on palpation) unilaterally, on the left foot but the typical anatomical site differs. It is exactly in the middle of her arch and sometimes it radiates dorally. She has a pes planovalgus foot type, no medical conditions, normal weigth, 30 years old, average daily activity. Should i be looking for something more other than plantar fasciitis?
    Thank you
     
  2. yvonneg

    yvonneg Member

    It sounds as though its around the site of insertion of peroneal longus? What are the biomechanics like? Apart from orthotic intervention, the treatment modal remains the same regardless of bone or soft tissue, strapping, rest, ice, elevation etc. So even if its not plantar fasciitis, you are still helping. Hope this helps.
     
  3. David Wedemeyer

    David Wedemeyer Well-Known Member

    Can this patient toe walk or is plantarflexion of the forefoot on the ground painful in the midfoot? What were the exam findings, is there Achilles tightness and equinus, any tenderness of the midtarsal joints? Could be more than one pathology occurring at the same time as well.
     
  4. Admin2

    Admin2 Administrator Staff Member

  5. PodGov

    PodGov Member

    Perhaps consider assessing for PTTD as well - multiple insertions for tibialis posterior muscle including bases of middle three metatarsals; especially in light of pes planovalgus and the pain radiating dorsally. I assume pain to be radiating medially to dorsal area?

    Cheers
     
  6. sdenisar

    sdenisar Member

    Exam details would be nice, but based on little detail would agree with PodGov. Workup PTTD. Any other pertinent findings?
     
  7. gkhaj

    gkhaj Welcome New Poster

    i agree sounds as though we have tibialis posterior dysfunction or possible partial rupture. A single heel rise test may confirm clincially. by the way where in athens do you practice. i travel to greece often to see family and never knew they were there.

    Regards

    George
     
  8. Timm

    Timm Active Member

    I would add Dorsal Interosseous Midfoot Compression syndrome (DIMCS) to your list of differentials. I see quite a bit of this in combination with plantar fasciosis as they tend to be related in mechanical aetiology. There are some really good threads if you searched them, one includes Kevin Kirbys newsletter on DIMCS which outlines assessment and management of the condition. May help to see If it fits in with your patients presentation
     
  9. docwerber

    docwerber Welcome New Poster

    Heel pain or arch pain has many differentials other than plantar fasciitis/ fasciosis. Consider fibroma, nerve entrapment, tarsal tunnel syndrome, lumbar radiculopathy, partial tear of the plantar fascia, posterior tibial tendon dysfunction, to name a few of the potential differentials. Imaging is important, weight bearing radiographs, diagnostic ultrasound or MRI if available would help in making your diagnosis.
    b
     
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