HISTORY: A 54 year-old female presented to our Sports Medicine clinic with 6 months of left heel pain. She was evaluated by podiatry and diagnosed with plantar fasciitis. Her pain persisted despite conservative measures. MRI showed plantar fascia tear with 2 mm retraction so they gave her steroid injections, placed her in a boot and referred to physical therapy. After 8 weeks, her pain worsened. Repeat MRI showed progression of the initial plantar fascia tear now with 4 mm retraction. An oral steroid significantly helped her pain temporarily. She was referred to us for PRP consultation. She reported her foot would intermittently get cold and was extremely sensitive to touch. She showed pictures of occasional swelling and discoloration of the left foot with mottled skin. PHYSICAL EXAM: She was ambulating with a walker. Left foot examination revealed mild swelling, severe hypersensitivity to light touch of the entire medial and plantar aspect, felt cool to touch, and active ROM of digits was limited. Pulses and reflexes were intact and symmetrical bilaterally. DIFFERENTIAL DIAGNOSIS: 1. Plantar fasciitis 2. Peripheral Neuropathy 3. Tarsal Tunnel Syndrome 4. Complex Regional Pain Syndrome (CRPS) TESTS/RESULTS: - CBC, CMP, TSH, HbA1c, B12, Folate all within normal limits - XR Foot: Diffuse osteopenia FINAL WORKING DIAGNOSIS:CRPS; Plantar fascia tear TREATMENT AND OUTCOMES: - Started topical analgesics, oral steroids, gabapentin; restarted physical therapy and placed back into a boot. - She had minimal improvement at follow up visits; Additional XR’s showed diffuse osteopenia; it was recommended that she start bisphosphonate therapy. Patient elected to get a bone scan/DXA prior to starting. - Patient has had minimal improvement in her pain and function despite recommended treatments for both plantar fasciitis and CRPS. Alternative treatments are being explored including perineural injection therapy, mirror therapy, and pain management consultation for lumbar sympathetic blocks