Posted in Patient Information

Plantar Fasciitis

Source: Am Fam Physician. 2001 Feb 1;63(3):477-478.

What is plantar fasciitis?

Plantar fasciitis is a common cause of pain in the heel of your foot. Your heel may hurt, feel hot, swell or turn red. This is called inflammation. The inflammation occurs in the plantar fascia, which is a thin layer of tough tissue that supports the arch of the foot. The pain is usually worse when you first get out of bed.

What causes plantar fasciitis?

The cause is usually some combination of tightness of the foot and the calf, weakness of the foot, improper athletic training or stress on the arch of the foot. Also, too much use (running too far, too fast, too soon), shoes that don’t fit, or certain play or work actions can hurt the plantar fascia.

How is plantar fasciitis treated?

Treatment can reduce or get rid of what is causing plantar fasciitis. Treatment can also lessen inflammation.

To decrease the stress on the plantar fascia, you may need to wear shoes with more arch support. You might even need to change the size of shoe you wear. Athletes and active people may need to spend less time doing actions that cause stress, like jogging, jumping or running. Sometimes, arch supports or special shoe inserts may be used.

Stretching and strengthening exercises are also good. Massaging your foot across the width of the plantar fascia before getting often helps lessen the from standing. Regular stretching will help your pain help prevent future episodes of pain.

Strengthening exercises may include towel curls, marble or coin pick ups and toe taps.

To do a towel curl, sit with your foot flat on the end of a towel placed on a smooth surface. Keeping your heel on the floor, pull the towel towad your body by curling up the towel with your toes. To do marble pick ups, put a few marbles on the floor near a cup. Keeping your heel on the floor, pick up the marbles with your toes and drop them in the cup. For a greater challenge, you may try to pick up coins instead of marbles.

To do toe taps, you will lift all your toes off the floor and, while heel on the floor and four toes in the air, toe to the floor (Picture 4). Next you will change the order and tap the outside four toes to the floor a number of times while keeping the big toe in the air. Start with 10 taps and work up to 50 taps per session.

Inflammation can be treated in several ways. An ice massage, ice bath or an ice pack may help.

For ice massage, freeze water in a small paper cup, then rub the exposed end of the ice over the painful heel using a circular motion and medium pressure for 5 to 10 minutes.

For an ice bath, fill a shallow pan with water and ice and soak your heel for 10 to 15 minutes. Wear neoprene toe covers (special covers you can buy at a medical supply store) or keep your toes out of the ice water to keep the cold from hurting your toes.

Make an ice pack by putting crushed ice in a plastic bag wrapped in a towel and molding it to the foot. Another good way is to use a bag of frozen corn wrapped in a towel. Use the package of corn for 15 to 20 minutes. Icing your heel after exercising, stretching, strengthening and working can help prevent inflammation.

Other treatments include medicines that lessen the inflammation or cortisone shots into the heel. Talk to your doctor about side effects and risks of these treatments.

Posted in Procedures

Subacromial Shoulder Injection

Consent Form

Equipment List

  1. Nitrile Exam Gloves (1 pair)
  2. Kenolog (Triamcinolone Acetonide) 40mg/mL (1 vial)
  3. 1% lidocaine (without epinephrine) (1 vial with minimum 10mL remaining)
  4. 10 mL syringe (1)
  5. 18 gauge 1.5 inch needle (1)
  6. 25 gauge 1.5 inch needle (1)
  7. Iodine swabs (2)
  8. Sterile 4×4 gauze (2)
  9. Alcohol Swabs (4)
  10. Band-Aid (1)

Procedure Note

SUBACROMIAL SHOULDER INJECTION

Risks and benefits were discussed, including treatment failure (no relief from this injection), new pain, swelling, and infection.  Specifically, the patient was counseled that in the first 72 hours it is common to have rebound worsening of pain symptoms, before improvement is noted.  Patient verbalized understanding and wished to go forward with procedure.  Verbal timeout performed, pausing to verify patient and procedure.

Patient remained in a seated position, posterior approach without ultrasound guidance.  Posterior acromion palpated.  The skin was prepped with iodine swabs.  40 mg of triamcinolone acetonide (1 ml of 40mg/ml) was drawn into a syringe with 9 ml of 1% lidocaine without epinephrine.  A 25 gauge 1.5" needle was used to inject all 10 ml into the subacromial space.  The patient tolerated the procedure well.
Posted in Procedures

Acromioclavicular Shoulder Injection

Consent Form

Equipment List

  1. Nitrile Exam Gloves (1 pair)
  2. Kenolog (Triamcinolone Acetonide) 40mg/ml (1 vial)
  3. 1% lidocaine (without epinephrine) (1 vial with minimum 2 ml remaining)
  4. 5 ml syringe (1)
  5. 18 gauge 1.5 inch needle (1)
  6. 25 gauge 1.5 inch needle (1)
  7. Iodine swabs (2), or 3 ml ChloraPrep swab (1)
  8. Sterile 4×4 gauze (2)
  9. Alcohol Swabs (4)
  10. Band-Aid (1)

Procedure Note

ACROMIOCLAVICULAR INJECTION

Risks and benefits were discussed, including treatment failure (no relief from this injection), new pain, swelling, and infection.  Specifically, the patient was counseled that in the first 72 hours it is common to have rebound worsening of pain symptoms, before improvement is noted.  Patient verbalized understanding and wished to go forward with procedure.  Verbal timeout performed, pausing to verify patient and procedure.

Patient remained in a seated position, superior approach without ultrasound guidance.  Posterior acromion palpated.  The skin was prepped.  40 mg of triamcinolone acetonide (1 ml of 40mg/ml) was drawn into a syringe with 2 ml of 1% lidocaine without epinephrine.  A 25 gauge 1.5" needle was used to inject all 3 ml into the acromioclavicular space.  The patient tolerated the procedure well.  No bleeding noted.
Posted in Patient Information

Orthopedic Handouts

Need a handout for a common orthopedic injury? Here are some from two great resources.

The Sports Medicine Patient Advisor, 3rd edition

note: These handouts are actually from an old 2nd edition. The third edition has much nicer, color, updated stuff. If you find these old ones useful you should definitely buy the newest edition.

Abdominal_Muscle_Strain.pdf

Achilles_Tendon_Injury.pdf

ACL_Injury.pdf

ACL_Reconstruction.pdf

Ankle_Fracture.pdf

Ankle_Sprain.pdf

Arch_Pain–Metatarsalgia.pdf

Athletes_Foot.pdf

Bakers_Cyst.pdf

Biceps_Tendonitis.pdf

Brachial_Plexus-Stinger.pdf

Bunion.pdf

Calcium.pdf

Calf_Strain.pdf

Carpal_Tunnel.pdf

Cast_Care.pdf

Clavicle_Fracture.pdf

Coccyx_Injury.pdf

Crutches.pdf

DeQuervains_Tenosynovitis.pdf

Dislocated_Shoulder.pdf

Exercise_Asthma.pdf

Exercise_During_Pregnancy.pdf

Finger_Dislocation.pdf

Finger_Sprain.pdf

Frozen_Shoulder.pdf

GameKeepers_Thumb.pdf

Ganglion_Cyst.pdf

Gluteal_Strain.pdf

Golfers_Elbow.pdf

Groin_Strain.pdf

Hamstring_Strain.pdf

Herniated_Disk.pdf

Hip_Flexor_Strain.pdf

Hip_Pointer.pdf

Ice_And_Heat_Therapy.pdf

Ingrown_Toenail.pdf

Iron.pdf

IT_Band_Syndrome.pdf

Knee_Scope.pdf

Labral_Tear.pdf

LCL_Sprain.pdf

Little_Leaguers_Elbow.pdf

Low_Back_Pain.pdf

Mallet_Finger.pdf

MCL_Sprain.pdf

Meniscal_Tear.pdf

Metatarsalgia.pdf

Mortons_Neuroma.pdf

MRI.pdf

Neck_Spasm.pdf

Neck_Strain.pdf

Olecranon_Bursitis.pdf

Osgood_Schlatters.pdf

Osteochondritis_Dissecans_Knee.pdf

Osteochondritis_Elbow.pdf

Over_Pronation.pdf

Patellar_Subluxation.pdf

Patellar_Tendonitis.pdf

Patellofemoral_Pain.pdf

Pelvic_Avulsion_Fracture.pdf

Peroneal_Tendon_Strain.pdf

Pes_Bursitis.pdf

Piriformis_Syndrome.pdf

Plantar_Fasciitis.pdf

Prepatellar_Bursitis.pdf

Quad_Strain.pdf

Rhomboid_Strain.pdf

Rib_Injury.pdf

Rotator_Cuff.pdf

Scaphoid_Fracture.pdf

Scope_Menisectomy.pdf

Severs_Calcaneal_Apophysitis.pdf

Shin_Splints.pdf

Shoulder_Bursitis.pdf

Shoulder_Subluxation.pdf

Snapping_Hip_Syndrome.pdf

Spondylolysthesis.pdf

Sprains.pdf

SternoClavicular_Separation.pdf

Strains.pdf

Stress_Fractures.pdf

Tennis_Elbow.pdf

TFCC_Injuries.pdf

Triceps_Tendonitis.pdf

Trigger_Finger.pdf

Trochanteric_Bursitis.pdf

Turf_Toe.pdf

Ulnar_Neuropathy.pdf

Wrist_Sprain.pdf

Wrist_Tendonitis__Intersection_Syndrome.pdf

Essentials of Musculoskeletal Care

Achilles Tendinosis or Tendinitis Home Exercise.pdf

ACL Tear Home Exercise.pdf

Acromioclavicular Injuries Home Exercise.pdf

Ankle Sprain Home Exercise.pdf

Arthritis of the Knee Home Exercise.pdf

Collateral Ligament Tear Home Exercise.pdf

Foot and Ankle Conditioning Home Exercise.pdf

Home Exercise Program for Frozen Shoulder

Hip Conditioning Home Exercise.pdf

Knee Conditioning Home Exercise.pdf

Lateral and Medial Epicondylitis Home Exercise.pdf

Low Back Pain Acute Home Exercise.pdf

Low Back Pain Chronic Home Exercise.pdf

Lumbar Spine Conditioning Home Exercise.pdf

Medial Gastrocnemius Tear Home Exercise.pdf

Home Exercise Program for Meniscal Tear

PatellarQuadriceps Tendinitis Home Exercise.pdf

Patellofemoral Pain Home Exercise.pdf

Home Exercise Program for PCL Injury

Home Exercise Program for Plantar Fasciitis

Plica Syndrome Home Exercise.pdf

Posterior Heel Pain Home Exercise.pdf

Rotator Cuff Tear Home Exercise.pdf

Shoulder Conditioning Home Exercise.pdf

Shoulder Impingement Home Exercise.pdf

SLAP Lesions Home Exercise.pdf

Snapping Hip Home Exercise.pdf

Strains of the Hip Home Exercise.pdf

Strains of the Thigh Home Exercise.pdf

Thoracic Outlet Syndrome Home Exercise.pdf

Toe Strengthening Home Exercise.pdf

Trochanteric Bursitis Home Exercise.pdf

Miscellaneous

Plantar-Fasciitis.pdf