G'day All,
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I've got case which has got my stumped, hope someone's got some ideas!
Male patinet, 52 years old, works as a stock agent suffering heel pain bilaterally for approx 5 months now after a particurly big day on feet. Described as an aching stabbing pain, worse with prolongued activity and hard working surfaces. Nil history of other foot, knee or hip pathology. Patient wears elastic sided boots to work, and sandals and slippers when at home. Pain is minimal in all footwear, but excessive when not in any footwear. Pain elicted when patient inverts feet and occurs in medial distal calcaneal region. Discomfort reproducable with direct palpation of insertion of plantar fascia approx 1 inch from insertion, however not reproducable anywhere else.
Biomechanically, patient demonstrates a mild forefoot supinatus bilaterally, compensated with a slightly planatrflexed 1st ray. Gait demonstrates delayed resupination at midfoot consistent with saggittal plane block and windlass failure (functional hallux limitus). Slight abductory twist with propulsion consistent with saggittal plane block also. Otherwise biomechanically unremarkable.
Nil relief with modified low-dye taping with false fascia, increased discomfort with 9mm PPT heel pads, nil relief with physical therapies: rest, ice, massage, topical NSAIDs.
Patient has today been refered for ultrasound to both heels.
Not quite sure how to tackle it as the pain is pretty much without footwear, and additions in the shoes makes it worse?
Any ideas?? :bang:
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