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Old 06-02-2011
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Rheumatology/Orthopedics Heel Pain Question

A 49-year-old male factory foreman has a 2-month history of increasingly sharp pain in the middle of the left heel that is not associated with trauma. The pain is most severe when he first gets out of bed in the morning, so that he often must tiptoe to the bathroom. It gradually lessens as he walks in the house and on the factory floor. Acetaminophen does not provide relief. His medical history is significant only for diet-controlled hypertension.
On physical examination, the patient is mildly obese. The left ankle is not tender to palpation and has full range of motion without pain. The Achilles tendon is not tender but has slightly decreased range of motion in dorsiflexion. There is no swelling or erythema of the plantar surface of the left foot. The heel is tender to palpation 4 cm from the posterior margin on the plantar surface. Mediolateral compression of the heel does not elicit tenderness. There is mild pes planus. Examination of the right foot is unremarkable.
Which of the following is the most appropriate treatment at this time?
( A ) Administration of acetaminophen with codeine
( B ) Injection of a long-acting corticosteroid at the site of pain
( C ) Use of orthotics and Achilles tendon-stretching exercises
( D ) Referral to a podiatrist for plantar fascia release
( E ) Referral to a podiatrist for neurectomy
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Old 06-06-2011
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C) conservative management for initial treatment of plantar fasciitis
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Internal-Medicine-, Rheumatology-, Step-3-Questions

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