When Heel Pain Is Not Plantar Fasciitis

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When Heel Pain Is Not Plantar Fasciitis - Page #1

Author: Anthony Shadiack, DO Co Author #1: Lisa Wright, MD Senior Editor: Siobhan Statuta, MD, FAMSSM Editor: Nicholas Feo, MD Patient Presentation: A 16 year old male offensive left tackle presented for reevaluation of a six-year history of uncontrolled left plantar foot pain. History: Several physicians diagnosed the patient with plantar fasciitis over the previous six years due to the pain localizing to his medial calcaneal tubercle. He had failed multiple rounds of physical therapy, anti-inflammatories, six weeks of a short-leg boot, hard orthotics, ultrasound wave therapy, and corticosteroid injections into the plantar fascia. Despite these interventions, the patient notes that pain is worse with activity. Physical Exam: Inspection: No swelling or rash. There is hyperpronation noted on bilateral feet and a positive "too-many-toes" sign bilaterally. Range of motion reveals decreased flexion and extension in the left ankle. Palpation elicits tenderness in the space posterior to the medial malleolus, tenderness to palpation of the medial calcaneal tuberosity. Special testing demonstrates a positive dorsiflexion-eversion test, Tinel's sign when pressure applied posterior to the medial malleolus, and a negative calcaneal squeeze test. Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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