Case Studies In Treating Chronic Plantar Fasciitis
At 18 days post-op, the patient presented with left calf pain that began the previous night. A physical examination revealed pain, swelling and tightness in the left gastrocsoleus complex. I immediately referred the patient to a vascular specialist and he diagnosed deep venous thrombosis (DVT). The vascular specialist prescribed enoxaparin sodium (Lovenox, Sanofi Aventis) and his DVT completely resolved with no further sequelae. At three months postoperatively, the patient had returned to all activity including running with no pain or symptoms in the left foot and a one-year follow-up visit revealed no symptoms with pain-free activity.
The in-step fasciotomy has the advantage of avoiding the neurovascular bundle and allows excellent visualization of the fascia the surgeon is transecting.11 Not allowing weightbearing for three weeks postoperatively does increase the risk of a DVT and one should consider prophylaxis, especially in those patients who have any risk factors.
The treatment of plantar fasciosis is not always predictable but it is important to develop a protocol that is sensible and consistent to allow the practitioner to determine which treatment works best. Anecdotally, I have found that the sooner one initiates conservative treatment, the more successful one is in resolving the pain. As with most pathology, the treating physician must address the potential causes and not focus solely on treating the symptoms.
Dr. Fullem is in private practice in Tampa, Florida. He is board-certified in foot surgery by the American Board of Podiatric Surgery and board-certified in foot orthopedics by the American Board of Podiatric Orthopedics and Primary Care Medicine. Dr. Fullem is a Fellow of the American Academy of Podiatric Sports Medicine (AAPSM) and is currently organizing the AAPSM’s first stand-alone conference in almost 20 years. The conference will take place March 14-16, 2014 in Tampa, Fla. For more info, e-mail Dr. Fullem at firstname.lastname@example.org .
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