Mistaken Identity

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Mistaken Identity - Page #1

Author: Namita Bhardwaj, MD Co Author #1: Jeremy Fleeks, MD Co Author #2: Bradley Henrie, MD Co Author #3: Winfred T. Frazier, MD, MPH Senior Editor: Adam Lewno, DO Editor: Donald Kasitinon, MD Patient Presentation: A 61 year old male with past medical history of class II obesity, degenerative joint disease (right knee), obstructive sleep apnea on CPAP, hyperlipidemia, and hypertension presented for right heel pain for over 6 months. History: The pain was described as sharp in nature. The pain was intermittent at first, and progressively worsened until it became nearly constant. Exacerbating factors included walking and being barefoot. Patient endorsed mild improvement with trial of ibuprofen, acetaminophen, and diclofenac. History was negative for tingling, numbness, ecchymosis, and edema of right lower extremity. Patient denied any inciting events. There were no previous surgeries or injuries reported for the right foot. Physical Exam: Blood pressure: 109/61 Pulse: 73 RR: 14 Temp: 98.1 F Height: 69 in Weight: 292 lbs. 6.4 oz. BMI: 43.18 kg/m2 General: Patient alert and oriented to person, place, and time. No acute distress. Musculoskeletal: Right Foot: Strength 5/5, full ROM, tenderness to palpation of plantar fascia, worsened with forced dorsiflexion of foot with patient reporting sharp pain along length of plantar fascia. Left Foot: Strength 5/5, full ROM, mild tenderness with palpation of plantar fascia, not worsened on exam. Skin: warm, dry, without ecchymosis. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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