PLAB 2 NewCase_2: Plantar fasciitis
- Ann Augustin
- Oct 29, 2024
- 4 min read
Updated: Nov 6, 2024
1. Which of the following are common presenting symptoms of plantar fasciitis? (Select all that apply.)
A) Heel pain upon taking the first steps in the morning
B) Swelling around the ankle
C) Sharp pain in the arch of the foot
D) Numbness in the toes
Answers
A) Heel pain upon taking the first steps in the morning
C) Sharp pain in the arch of the foot
E) Pain that decreases with activity
Explanation:
Plantar fasciitis typically presents with heel pain that is worst with the first steps after waking up. The pain can also be sharp and located in the arch of the foot. It often decreases as the foot warms up with activity. Swelling around the ankle and numbness in the toes are not characteristic symptoms.
2. How might plantar fasciitis impact a patient's daily life? (Select all that apply.)
A) Difficulty standing for long periods
B) Interference with exercise routines
C) Trouble climbing stairs
D) Discomfort while driving
Answers
A) Difficulty standing for long periods
B) Interference with exercise routines
C) Trouble climbing stairs
Explanation:
Patients with plantar fasciitis may struggle with activities that put prolonged pressure on the feet, such as standing or exercising. Climbing stairs can exacerbate the pain. Discomfort while driving is less common, and while some may experience sleep disturbances, it is not a hallmark of the condition.
3. What are common patient complaints during daily activities with plantar fasciitis? (Select all that apply.)
A) Pain when standing after sitting for a long time
B) Difficulty walking barefoot
C) Pain that worsens at the end of the day
D) Swelling around the toes
Answers
A) Pain when standing after sitting for a long time
B) Difficulty walking barefoot
C) Pain that worsens at the end of the day
Explanation:
Patients may experience pain after periods of rest (post-static dyskinesia), difficulty walking without footwear due to lack of support, and increased pain after prolonged activity. Swelling around the toes and calf cramping are not typical complaints.
4. What are the possible differential diagnoses for plantar fasciitis? (Select all that apply.)
A) Achilles tendinopathy
B) Calcaneal stress fracture
C) Tarsal tunnel syndrome
D) Morton's neuroma
Answers
A) Achilles tendinopathy
B) Calcaneal stress fracture
C) Tarsal tunnel syndrome
E) Rheumatoid arthritis
Explanation:
Differential diagnoses include Achilles tendinopathy (pain at the back of the heel), calcaneal stress fractures (heel pain with weight-bearing), tarsal tunnel syndrome (nerve entrapment causing foot pain), and rheumatoid arthritis (which can cause foot pain and stiffness). Morton's neuroma typically affects the forefoot, not the heel.
5. Which investigations are useful in diagnosing plantar fasciitis? (Select all that apply.)
A) X-ray of the foot
B) Ultrasound imaging
C) MRI scan
D) Blood tests for inflammatory markers
Answers
A) X-ray of the foot
B) Ultrasound imaging
C) MRI scan
Explanation:
An X-ray may reveal a calcaneal spur or rule out fractures. Ultrasound and MRI can show thickening of the plantar fascia. Blood tests may be useful if an inflammatory arthropathy is suspected but are not diagnostic for plantar fasciitis. Nerve conduction studies are not typically indicated.
6. During physical examination, which signs are indicative of plantar fasciitis? (Select all that apply.)
A) Tenderness at the medial calcaneal tubercle
B) Swelling over the dorsum of the foot
C) Limited ankle dorsiflexion
D) Pain with passive toe extension
Answers
A) Tenderness at the medial calcaneal tubercle
C) Limited ankle dorsiflexion
D) Pain with passive toe extension
Explanation:
Key examination findings include tenderness at the point where the plantar fascia attaches to the heel bone (medial calcaneal tubercle), limited ankle dorsiflexion due to tight calf muscles, and pain when the toes are passively extended. Swelling over the dorsum of the foot and a positive Tinel's sign are not typical of plantar fasciitis.
7. Which examination techniques are useful in assessing plantar fasciitis? (Select all that apply.)
A) Palpation of the heel and plantar fascia
B) Assessing ankle range of motion
C) Squeeze test of the forefoot
D) Observing gait and foot posture
Answers
A) Palpation of the heel and plantar fascia
B) Assessing ankle range of motion
D) Observing gait and foot posture
Explanation:
Palpation can identify tenderness. Limited ankle dorsiflexion can contribute to plantar fasciitis. Gait and foot posture assessment can reveal biomechanical issues. The squeeze test is for Morton's neuroma, and leg length discrepancy is less relevant.
8. How would you explain plantar fasciitis to a patient in layman's terms? (Select all that apply.)
A) "The tissue supporting your foot arch is inflamed."
B)"There's a small fracture in your heel bone causing pain."
C)"The bone in your heel is worn down, leading to pain."
D) "The ligament in your foot is strained from overuse."
Answers
A) "The tissue supporting your foot arch is inflamed."
D) "The ligament in your foot is strained from overuse."
Explanation:
These explanations accurately describe plantar fasciitis in simple terms. It involves inflammation or overuse of the plantar fascia, the ligament supporting the foot arch. It is not caused by a fracture, cushioning loss, or nerve issues causing tingling.
9. What lifestyle modifications can help manage plantar fasciitis? (Select all that apply.)
A) Wearing supportive footwear with good arch support
B) Performing regular calf and foot stretching exercises
C) Increasing running or high-impact activities
D) Losing excess weight if overweight
Answers
A) Wearing supportive footwear with good arch support
B) Performing regular calf and foot stretching exercises
D) Losing excess weight if overweight
Explanation:
Supportive footwear reduces strain on the plantar fascia. Stretching exercises improve flexibility. Weight loss decreases pressure on the feet. Increasing high-impact activities and walking barefoot on hard surfaces can worsen symptoms.
10. Which medications might be prescribed for plantar fasciitis? (Select all that apply.)
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Corticosteroid injections
C) Oral corticosteroids
D) Opioid analgesics
Answers
A) Nonsteroidal anti-inflammatory drugs (NSAIDs)
B) Corticosteroid injections
Explanation:
NSAIDs help reduce pain and inflammation. Corticosteroid injections can provide temporary relief. Oral corticosteroids are not commonly used due to systemic side effects. Opioids are generally avoided, and antidepressants are not indicated for plantar fasciitis.
11. In addition to lifestyle changes and medication, what other treatments may be necessary for plantar fasciitis? (Select all that apply.)
A) Physical therapy
B) Night splints
C) Extracorporeal shockwave therapy
D) Surgical release of the plantar fascia
Answers
A) Physical therapy
B) Night splints
C) Extracorporeal shockwave therapy
D) Surgical release of the plantar fascia
Explanation:
Physical therapy can aid recovery. Night splints keep the foot in a dorsiflexed position, stretching the fascia. Shockwave therapy stimulates healing. Surgery is a last resort if conservative measures fail. Chemotherapy is not a treatment for plantar fasciitis.
12. What is the primary goal in managing plantar fasciitis? (Select all that apply.)
A) Reduce inflammation and pain
B) Stretch and strengthen the plantar fascia
C) Cure the condition with antibiotics
D) Improve foot biomechanics
Answers
A) Reduce inflammation and pain
B) Stretch and strengthen the plantar fascia
D) Improve foot biomechanics
E) Prevent recurrence
Explanation:
Management focuses on relieving symptoms, stretching and strengthening the plantar fascia, correcting foot mechanics, and preventing recurrence through lifestyle modifications. Antibiotics are not used as plantar fasciitis is not an infection.
13. What safety netting advice should be given to a patient with plantar fasciitis? (Select all that apply.)
A) "Return if symptoms don't improve after a few weeks."A) "
B) "Seek immediate help for sudden, severe heel pain."
C) "No need to follow up unless you have new health issues."
D) "Monitor for side effects if receiving injections."
Answers
A) "Return if symptoms don't improve after a few weeks."
B) "Seek immediate help for sudden, severe heel pain."
D) "Monitor for side effects if receiving injections."
Explanation:
Patients should be advised to return if there's no improvement, as alternative treatments may be needed. Sudden, severe pain could indicate a rupture of the plantar fascia. Monitoring for side effects after injections is important. Regular follow-up is recommended, and worsening symptoms should not be ignored.
14. Should a referral be made for a patient with plantar fasciitis, and to which specialist? (Select all that apply.)
A) Yes; refer to an orthopedic surgeon
B) Yes; refer to a podiatrist
C) Yes; refer to a neurologist
D) No; manage entirely in primary care
Answers
A) Yes; refer to an orthopedic surgeon
B) Yes; refer to a podiatrist
Explanation:
Referral to an orthopedic surgeon or podiatrist is appropriate for specialized care, especially if conservative treatments fail. A rheumatologist may be involved if an inflammatory condition is suspected. Management often begins in primary care but may require specialist input.
15. Which factors can contribute to the development of plantar fasciitis? (Select all that apply.)
A) Obesity
B) High arches or flat feet
C) Occupations requiring prolonged standing
D) Sedentary lifestyle
Answers
A) Obesity
B) High arches or flat feet
C) Occupations requiring prolonged standing
E) Age between 40 and 60
Explanation:
Risk factors include obesity (increased foot strain), foot mechanics (high arches or flat feet), occupations with prolonged standing or walking, and middle age. A sedentary lifestyle is less directly associated with plantar fasciitis.
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