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Introduction

Crohn’s disease (CD) is an inflammatory bowel disease affecting any portion of the gastrointestinal tract, usually the terminal ileum and the colon, with clinical manifestations such as diarrhea, fever, and weight loss [1]. Both Crohn's disease and ulcerative colitis (UC) are linked to several chronic inflammatory conditions that impact other organ systems and are frequently seen in IBD patients [2]. In clinical practice, there is a predominance of intestinal involvement and common symptoms such fever, stomach pain, weight loss, bloody/watery diarrhea, and anemia are present [3]. Clinical presentation of CD may include complications such as enterovesical fistulas, abscesses, strictures, and perianal disease. CD also classically presents with “skipping lesions,” unlike ulcerative colitis (UC), which presents with continuous lesions [4]. IBD predominantly affects the gastrointestinal system but it is associated with a large number of extraintestinal manifestations (EIMs) [5]. There are two types of extra-intestinal manifestations: Immune-related manifestations of IBD and autoimmune disorders independent of intestinal activity [6]. With a predominance of asymmetric joint involvement typically affecting the knees and ankles and the disease reflecting gastrointestinal activity, peripheral arthritis (PA) manifests in 2.8%–31% of IBD patients and 6% to 50% cases, enthesitis is a frequent seronegative arthropathy [7]. It is believed that the inflammatory processes involved in Crohn's disease may also contribute to the development of arthritis in susceptible individuals [8]. When a patient has plantar fasciitis, they typically complain of discomfort that is confined to the plantar medial aspect of the heel along the insertion of the plantar fascia. "Plantar fasciitis" indicates an inflammatory process to the plantar fascia [9]. Getting adequate therapy for the underlying cause is crucial when foot pain, specifically plantar heel pain is caused by intestinal inflammation. Ankle and heel joint and tendon discomfort should subside as Crohn's disease symptoms are treated and minimized [10]. The exact mechanisms underlying the relationship between plantar fasciitis and the development of EA in Crohn's disease are not fully understood [11]. IBD should be treated by halting disease development, individually modifying treatment approaches and thorough screening for long-term consequences. Here, we present a case of a patient with multiple intestinal ulcers associated with recurrent plantar Fasciitis. The purpose of this article is to focus on the plantar fasciitis as first extraintestinal manifestations of Crohn’s Disease and to reveal that IBD-related recurrent planter fasciitis responds excellently to systemic steroid therapy.

Case Presentation

A nineteen-year-old young girl presented with a six-month history of post-prandial fullness, diffuse abdominal pain, nausea, and occasional vomiting. During the six-month period, she also experienced several episodes of non-bloody diarrhea with high-grade fever and significant weight loss. She also developed two episodes of severe heel pain, each episode of which was associated with loose motions. The heel pain was consistent with a diagnosis of plantar fasciitis.

The patient described her pain as feeling like a stabbing at the base of her heel. Her pain was very bad first thing in the morning as she got out of bed. It would subside and feel more like a dull aching after some time of moving around. On physical examination, she was anemic and nutritional status was below average, and had abdominal tenderness without any lump. Upon visual examination of the soles of the feet, there is no swelling or redness around the heel. She has no tenderness to palpation over the tibia, fibula, malleoli, tarsals, metatarsals, metacarpophalangeal joints, or digits. She had tenderness to palpation over the medial calcaneal tubercle and discomfort with passive dorsiflexion of the first toe. She has a normal strength of dorsiflexion and plantar flexors. She had a normal range of motion with inversion, eversion, and plantar flexion. There was no evidence of any joint inflammation. She was put on conservative management to facilitate recovery, including appropriate footwear at work, stretching, and massage along with the oral corticosteroid [40 mg per day]. She responded well to systemic steroid therapy which was actually given to alleviate the gut inflammation and steroid injection in plantar fascia was not required for this patient.

Discussion

This study presents a patient who had all the typical symptoms of crohn’s disease including diffuse abdominal pain, nausea, and occasional vomiting, several episodes of non-bloody diarrhea with high-grade fever and significant weight loss. The patient had several intestinal ulcers and recurrent plantar fasciitis as extraintestinal manifestations of inflammatory bowel disease (Crohn's Disease).

A variety of symptoms related to intestinal and extraintestinal manifestations might be present in people with inflammatory bowel disease. The most frequent extraintestinal IBD signs are musculoskeletal symptoms, which may be present in 30% of patients [12]. It has been observed that the predominance of untreated EIMs in IBD can lengthen the disease's course, reduce quality of life, promote intestinal fibrosis as a means of healing, promote cachexia related to IBD, increase the risk of malignancy, and generally increase morbidity and death [13]. Six months of history are given in this case study. In addition to stretching, massage, and the oral corticosteroid (40 mg per day), the patient was placed on conservative care to speed recovery. Systemic steroid medication, which was r administered to her to reduce the inflammation in the gastrointestinal tract, had a positive effect on her. Both Crohn's disease and ulcerative colitis are systemic conditions that frequently affect other organs, even though the gastrointestinal tract is typically the primary area of concern [14] so, bowel is the major target of treatment. For this patient, a plantar fascia steroid injection was not necessary. Additional invasive procedures may be necessary if a patient's symptoms last six months or longer. With conservative treatments, 90% of patients will get better [15] Nevertheless, it has been demonstrated that intensive early therapy and continued treatment of EIMs may prevent serious consequences [13]. More research is also needed to better understand the dose–response relationship of oral corticosteroid for the treatment of IBD with recurrent plantar fasciitis as first extraintestinal manifestation (Figure 1-8).

Conclusion

Plantar fasciitis has many causes such as calcaneal spur, autoimmune disease, rheumatologic disorders, and ankylosing spondylosis. Plantar fasciitis in Crohn’s disease patients as the first extraintestinal manifestation is much more significant as it sometimes indicates the risk of development of other musculoskeletal manifestations like arthritis in the future & hence warrants early surveillance and treatment for both symptomatic and asymptomatic plantar fasciitis in Crohn’s disease.