American Board of Internal Medicine (ABIM) Certification Practice Exam

What is a potential risk associated with glucocorticoid injections for plantar fasciitis?

1. Excessive swelling

2. Fat atrophy in the heel pad

3. Increased bone density

4. Delayed healing

The correct answer is: Fat atrophy in the heel pad

Glucocorticoid injections are commonly used to reduce inflammation and alleviate pain in conditions like plantar fasciitis. One potential risk associated with these injections is fat atrophy in the heel pad. When glucocorticoids are injected into or around soft tissues, they can lead to localized fat atrophy, particularly in the weight-bearing areas such as the heel. This is because glucocorticoids can influence fat cell metabolism, leading to the breakdown of adipose tissue and resulting in thinning of the subcutaneous fat that typically provides cushioning for the heel. This complication can be particularly concerning as it might not only exacerbate pain but could also lead to further biomechanical issues due to decreased shock absorption, thus impacting mobility and overall patient comfort. In the context of plantar fasciitis, maintaining the appropriate cushioning and support in the heel is crucial for optimal outcomes, making awareness of fat atrophy an important consideration for healthcare providers when recommending glucocorticoid therapy. In contrast, excessive swelling is typically not a direct risk associated with glucocorticoid injections; usually, these injections aim to reduce inflammation. Increased bone density is not a characteristic effect of glucocorticoids, as they tend to have the opposite effect, potentially leading