Case study: Plantar fasciopathy – Injection
A 50-year-old woman, who has hypothyroidism, visited with complaints of persistent heel pain that had been ongoing for six months. The pain was primarily localized over the heel and extended to the Achilles tendon and increased on getting out of bed. Despite trying NSAIDs and wearing specialized microcellular rubber footwear, she did not experience any significant relief. Even applying ice packs only offered minimal temporary relief.
Physical examination
- Pes planus (flat feet)
- Calcaneal jump sign: Positive
- Windlass test: Positive
Ultrasound findings
- Plantar fascia tears
- Calcaneal spur
Longitudinal view of the plantar heel showing a small tear in the plantar fascia and a calcaneal spur.
Longitudinal view of the plantar heel showing small tears in the plantar fascia.
- Color Doppler: No visible neoangiogenesis
Color Doppler examination of the plantar fascia shows no visible neoangiogenesis.
- Perifascial fluid accumulation: Indicative of acute inflammation
Longitudinal view of the heel showing a small tear in the plantar fascia as well as perifascial fluid accumulation.
- Achilles tendon calcification
- Retrocalcaneal bursitis
Longitudinal view of the Achilles tendon showing calcification of the tendon and retrocalcaneal bursitis.
Transverse view of the Achilles tendon showing calcification of the tendon.
Diagnosis
The patient was diagnosed with plantar fasciopathy and Achilles tendinopathy. Plantar fasciopathy is a frequent underlying condition responsible for heel pain. It involves inflammation of the plantar fascia and is typically triggered by repetitive tension and stress. On the other hand, Achilles tendinopathy refers to the damage sustained by the Achilles tendon and is a prevalent injury resulting from overuse.
To read more about the treatment, patient outcome, and other case studies, download the most practical app on ultrasound-guided chronic pain blocks for management of the chronic pain HERE.
