American Board of Internal Medicine (ABIM) Certification Practice Exam

Which treatment option remains for plantar fasciitis after conservative therapies fail?

1. Continuous immobilization

2. Plantar fascia release

3. Only glucocorticoid injections

4. Long-term NSAID use

The correct answer is: Plantar fascia release

Plantar fascia release is considered a treatment option when conservative therapies for plantar fasciitis have failed. This surgical intervention is aimed at relieving tension on the plantar fascia and alleviating pain associated with this condition. When conservative measures, such as rest, physiotherapy, orthotics, and corticosteroid injections, do not yield sufficient relief, surgical options may be explored. The rationale behind choosing plantar fascia release involves the understanding that chronic cases of plantar fasciitis can lead to significant mechanical overload and structural damage to the fascia, which may not respond adequately to non-surgical interventions. Surgical release can decrease the tension along the fascia and potentially offer significant relief, allowing individuals to return to their normal activities with less pain. In contrast, continuous immobilization, while it may provide temporary relief, does not address the underlying problem effectively and could lead to stiffness or further complications. Sole reliance on glucocorticoid injections is also limited; while they may reduce inflammation, they do not provide a permanent solution and repeated use can have adverse effects. Long-term NSAID use could manage pain but lacks the corrective effect necessary for persistent cases. Ultimately, when faced with a situation where conservative methods have proven insufficient, plantar fascia release stands out as an appropriate next step for managing and