Esophageal leiomyoma

1) Disease Description (Causes and Symptoms)

• Definition/Pathophysiology: The plantar fascia is a thick band of fibrous tissue that begins at the calcaneus (heel bone), crosses the sole of the foot, and attaches to the bases of the toes; it supports the arch of the foot and absorbs shock during walking. Repetitive overuse or excessive loading causes microdamage, inflammation, and fibrosis of the plantar fascia, resulting in pain.
• Main Causes/Risk Factors:
  • Prolonged standing or repetitive weight-bearing activities such as walking/running (climbing stairs, hiking, jogging, aerobics, etc.)
  • Obesity or sudden weight gain
  • Flat feet or excessive arch (cavus foot), structural abnormalities of the feet
  • Uncomfortable footwear (hard soles, very low heels, tight shoes), high heels
  • Sudden increase in exercise volume, trauma from jumping or falling
  • Underlying conditions such as diabetes or arthritis (increased risk)
• Clinical Symptoms:
  • Severe medial heel pain with the first step in the morning (the first few steps) or immediately after standing up following prolonged sitting
  • Worsening after prolonged walking or exercise
  • Localized tenderness on the medial heel; shortening of the Achilles tendon is commonly associated
• Differential Diagnosis: Consider plantar fat-pad atrophy, calcaneal stress fracture, heel bursitis, and neuropathy (such as mononeuropathy)

2) Treatment Methods and Precautions

• Conservative Treatment (improvement occurs in most cases, over 90%):
  • Activity modification and weight loss: Reduce high-impact activities such as running and jumping in the early stages of pain
  • Footwear modification: Shoes with cushioned soles, a slightly elevated heel, and an appropriate fit are recommended
  • Plantar fascia and calf (Achilles) stretching: Perform regularly every day (guidance from a physical therapist is recommended)
  • Night splint: Keeps the plantar fascia in a stretched position at night and helps improve symptoms (usually over several weeks to several months)
  • Orthotics/inserts: Correct structural problems such as flat feet or cavus feet
  • Physical therapy: Massage, ultrasound, contrast baths, and taping
  • Pain control: Short-term use of nonsteroidal anti-inflammatory drugs (NSAIDs) may be possible
  • Extracorporeal shock wave therapy (ESWT): Considered for patients with chronic symptoms unresponsive to conservative treatment
  • Injection treatment: Steroid injections (single use in severe cases; repeated injections are generally not recommended) — caution is required because of the risk of fat-pad atrophy and fascial rupture
  • Invasive nonsurgical treatments such as platelet-rich plasma (PRP) are selective options, and the evidence varies
• Surgical Treatment:
  • Partial plantar fascia release and other procedures may be considered when severe pain and functional impairment persist despite appropriate conservative treatment for more than 6 months
• Precautions/Complications:
  • Repeated steroid injections carry a risk of plantar fat-pad atrophy and plantar fascia rupture
  • If left untreated for a long time, gait disturbance and persistent chronic pain may occur
  • Patients with diabetes or peripheral neuropathy should be cautious about infection and wound-healing problems
• Prognosis:
  • Most cases improve with conservative treatment, but complete recovery takes several weeks to several months (wearing orthotics for 2–3 months is recommended). Some cases become chronic and require additional treatment

3) Checklist Before an Outpatient Visit (Items and Records to Prepare)

• Items/Materials to Bring:
  • List of currently used medications (especially anticoagulants, steroids, etc.)
  • Past medical history (diabetes, rheumatoid disease, etc.) and surgical history
  • Records of recent weight changes
  • Photos of your shoes or the actual shoes you normally wear
  • Previous test results (foot X-ray, ultrasound, MRI, etc.) or relevant medical records
• Symptom Record (Information to Explain to the Doctor):
  • When the pain began and its course (when it worsened)
  • Characteristics of the pain (whether there is pain with the first step in the morning, worsening after walking, etc.)
  • Location of the pain (exact area) and intensity (pain score)
  • Factors that worsen or improve it (exercise, footwear, stretching, etc.)
  • Previous treatments (orthotics, physical therapy, injections, etc.) and the response
• Useful Measurements to Take Before the Appointment:
  • The distance at which discomfort is felt while walking (e.g., how many meters?)
  • Whether daily activities are limited

4) Examples of General Questions to Ask the Doctor

• "What is the cause of this condition, and what are the risk factors in my case?"
• "How quickly am I likely to improve with conservative treatment? What is the prognosis?"
• "What are the benefits and side effects of oral medications or injection treatment?"
• "How should I do rehabilitation (stretching and exercise), and how often?"
• "When would surgery be considered if it is necessary? What are the expected benefits and complications of surgery?"

5) Examples of Condition-Specific Questions

• "What type of night splint is appropriate, and how many hours per day and for how many months should I wear it?"
• "I have flat feet (or cavus feet). Do I need a prescription for custom orthotics? How much improvement can I expect from them?"

(This condition is diagnosed primarily on the basis of clinical findings. When necessary, X-rays are used to differentiate fractures and bone spurs, and additional evaluation with ultrasound or MRI may be considered for chronic or atypical symptoms.)