Heel Spur and pain misdiagnosis

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Dear all,

One of my regular pts had a very sore heel last week.

Now of course we were his first port of call.:bang:

So he went to the GP describing extreme pain in his right heel especially on standing, only had it a few days.

So off for X RAY and yup large Calcaneal Spur evident. Radiology report stated large heel spur evident with thickening of plantar fascia and degenerative oa change.

Advised to get Ultrasound investigations. Pt misunderstood and thought he had to have ultrasound t/t for this.

So came to see me.:drinks

o/e Both feet 3 4 5 digits severe chill blains, r thumb and 3 rd finger apex severe chilling with evidence of chill blain. R calc 3 large chill blains.

Could not elicit any pain from Heel spur but pt squealed on application of light pressure to his calc chillblains.

He is elderly not in great shape with advanced pvd . His nose was also severely chilled with micro thrombi at its apex.

What is it about Aussies that they allow themselves to get this severely chilled in their own 2 million dollar homes. It has been as cold as 3c outside at night and 7c in the day. But i can guarantee the home is colder than this. So the pt is freezing to death in thier own home.

So t/t plan heat the home, spend your kids inheritence , wear warm clothes knee length socks and proper footwear whan in doors and outside gloves and good coat. Keep the cold out and the warmth in. Also advised to get Vascular Assessment and Investigations.

This poor guy's heel was border line ulcerated. One wonders if his GP examined the feet and what the radiographer saw when he radiographed the CYANOTIC CHILLED FOOT.

Oh well hopefully he will be restored to rude foot health when it warms up.

People here have no idea how quietly COLD gets a grip in the elderly frail pt.:butcher:

regards David

 

Chilblains! Have seen them misdiagosed as many things.

When you hear hoofbeats, what do you think it is? Horses or Zebras? Always go for the obvious.

 

G'day David,

Living in a beautiful regional area of Victoria, I do see a lot of this happening, especially we are often a few degrees colder than in Melbourne. Ischaemia due to PVD in cold weather often leave my patients to the point of pain and in some cases ulceration in winter. Unfortunately it is a case of education of the patients to keep warm, and when they are in a habit of not using the heater due to costs, or for whatever reason, it can be a difficult habit to break. There is also an issue of patients, especially in affluent areas, being assset rich by owning a very expensive house, but being money poor, and can not afford simple things like running the heating and looking after themselves. One interesting thing that one of my doctors has implemented with one of my PVD patients is teh prescription of transdermal nitro patches. These are cut in half, and then applied to teh feet and stay on all week. Helps in vasodialation of the foot vessels and drastically reduces the ischaemic pain and chillblains... interesting idea?

Cheers!