525 - A blooming calcaneal bone stress injury in a female flower farmer

Case Diagnosis: Plantar fasciopathy (PF) with associated calcaneal bone spur stress injury (BSI).

Case Description: A 59-year-old female flower farmer with a past medical history of bilateral knee osteoarthritis and resolved right PF presents with 1.5 months of left heel pain. She reports using her left heel to repeatedly drive her shovel to dig or break up soil occasionally encountering rocks. Her footwear of choice are hard-soled clogs. She is unsure if the pain resembles previous contralateral PF and has been performing plantar fascia stretching and ice massage without relief. On examination, the left medial calcaneus and medial plantar fascia insertion site are tender to palpation and she experiences left heel pain with heel-walking. Left foot X-Ray reveals plantar calcaneal bone spur and Magnetic Resonance Imaging (MRI) shows plantar fasciitis with a small partial tear and adjacent edema of the calcaneal bone spur secondary to stress changes. She was counseled on shoveling mechanics and prescribed physical therapy and extracorporeal shockwave therapy for PF and BSI.

Discussions: Heel pain is a common farming-associated injury, with a reported prevalence of 24% though etiologies have not been further assessed. This patient likely developed a calcaneal bone spur and plantar fasciopathy as a result of long-term stress on her plantar fascia from prolonged periods of standing and ambulating and a bone stress injury at the spur from repeated trauma of using her left heel to apply pressure to her shovel.

Conclusions: Farmers may be at an increased risk for developing plantar fasciopathy due to the standing and ambulating requirements of the occupation. Farming-specific hazards such as repeated, increased pressure at the heel from shoveling may increase risk for traumatic bony injury and should be considered when assessing heel pain in this population.