Hi all,
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wondering if i can pick your brains knowledge and experience of plantar fibromatosis.
Case
32 yo female mechanic develops pain in medial band of p/fascia, GP gave oral anti inflams and sent pt away, saying pt was just overweight. X-rays then obtained, no sign of spurs present. Pt having great difficulty walking at this stage, with sharp stabbing pains at med calc tubercule and along med band p/fascia, worst in the morning. New footwear obtained and pain reduced slightly in day to day work. , where pt is standing for long hours on concrete floor.
At this point, sees pod, begins strapping regime of j strap and low dye, gives great reief of syptoms, , starts exercise therapy of ice/massage, stretching. Pain continues to improve with repeatd strapping, casted for custom made orthoses, help but do not produce the same results as strapping. Pt takes two weeks off work and at end of period is pain free all day. A further review shows pain has returned and much more severe.
another x-ray is taken and small spurs are seen to be forming to both med calc tubercle and post calc. Pts GP conducts cortisone injections into both plantar calc regions, through palpation. After the second injection in the left, pt is advised to discontinue by pod
This is where I step in having consultation with pt. I have ordered an ultrasound, which showed a 11mm difference in thickness of plantar fascia from the left to the right, plantar fibromatosis, inflammmation of both plantar fascia and overlying bursitis.
A night splint was ordered for the pt before i consulted, and pt has begun to use this on a nightly basis. I have also begun weekly massage, and ultrasound regime, and monitoring of situation.
Pt is at a point she can barely bear weith on calcs, left much worse than right and at the end of her tether. I have also suggested consult with a sx to look into cortisone injection under ultrasound guidance, though am wary of this as she has already had no luck, though intial injections were only with palpation.
Can anyone suggest further ideas of intervention.. am also tossing up idea of Extracorpel wave therapy, any suggestions of where I could approach to look into this servie in Melbourne?
I appreciate any comments or suggestions you can offer.
Thanks for you time, i know it has been long winded- have a nice day!
Liz
Ultrasound is referred for and
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