Hi! Hoping to get some advice for an elderly patient I am seeing (as a student)with which I am struggling for differentials
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She C/O pain in the left foot localised to a small (2cm^2), well defined, superficial area approx. 2cm distal to the medial tubercle of the calcaneous (I marked it spot on with a dot). Pain is elicited with mild pressure on palpation, however appears to be slightly diminished whilst the foot is completely dorsiflexed with soft tissue structures at stretch :confused:
She notes that pain in both feet (L>R) had begun in Feb this year after a long walk with grandkids along the beach. She experienced difficulty walking on the sand but the sharp pain only began first thing the next morning.
She has had Knee Sx which has left her with a secondary LLD L>R by roughly 2-3cm. I have made up some formies for her with a 1cm lift to the right which she wears with Asics 1130's. She has found the right is "perfect" and resolved the pain on that foot, however the L is still causing problems. We tried her with an "orthotix" off-the-shelf on the L for 2 weeks but still no better.
She has casual flats with no support which she finds more comfortable.
I have sent her for an ultrasound and ground a cavity to the area (at about the proximal, lateral 1/3 of the arch) which she said automatically reduced the pain.
Im lost for ideas as to what this could be??
Any suggestions?
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