Disorders of Fascia

Question 1

Plantar fasciitis

Answer 1

Etiology: repetitive microtrauma and biomechanical overuse. S/S: sharp and stabbing heel pain that is most severe in the morning or standing after rest. PE: physical examination, there is localized tenderness upon palpation of the medial calcaneal tubercle. Passive dorsiflexion of the hallux may cause pain or discomfort in the plantar fascia.

Dx: clinical

Tx: Conservative - (stretching, adding and strapping of the arch, supportive shoe gear, rest and avoidance of high impact activities). Surgical - Plantar fasciotomy (if failed therapy after one year).

Question 2

Necrotizing fasciitis

Answer 2

Causes:

Type 1

Polymicrobial (4-5 organisms), facultative anaerobes

Follows surgery, trauma, bowel perf, skin popping

Type 2

Monomicrobial, usually Grp A strep, also MRSA

Usually healthy pt, risk factors: DM, ETOH

Clinical presentation:

Severe cellulitis + systemic toxicity and severe pain, bullae

Ecchymosis that precedes necrosis, gas by exam or studies

Anaesthesia in affected area due to nerve destruction

Diagnostic workup: clinical judgment, surgical emergency

Initial management: surgical exploration and debridement, broad spectrum antibiotics (carbapenems)

Question 3

Fourniers gangrene

Answer 3

Causes: Type 1 necrotizing fasciitis (see above)

Clinical presentation: necrotizing fasciitis localized to scrotum

Diagnostic workup: clinical judgment, surgical emergency

Initial management: surgical exploration and debridement, broad spectrum antibiotics (carbapenems)