The other month were discussing this condition ...
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Here is some Highlights
Anyways had a patient come in the other day with long standing heel pain.
Started 9 years ago focused in the area of the medial plantar calc.
Was diagnosed as a Heel Spur by a local Sports Med Dr - treatment has included, Acupuncture, EVA full length insoles with met dome, Shock wave treatment, Soft heel spur pads, Cortisone injections * 2 all of which have not helped and the pain id slowly getting worse and more diffuse.
The patient has has 3 MRI which have come back as unremarkable except the last one in Feb 2011 -
- Insignificant change in the Plantar Fascia
- Some changes but minimal edema subcutaneous at the insertion of the plantar fascia but not significant for Plantar fasciitis
-no heel spur or significant edema at the insertion of the plantar fascia
But he is in significant pain on every step and has stopped all activities and now the pain is in the whole calcaneal area.
I performed the squeeze test Fredrik wrote about the the patient hit the roof - so made a preliminary diagnosis of Calcaneal Bone Marrow Edema/microfracture of plantar calcaneus.
I have some MRI picture which I will try and load up - Can anyone help make a better diagnosis ?
What would be the steps in treatment for a patient with Calcaneal Bone Marrow Edema/microfracture of plantar calcaneus who has been in pain for 9 years ?
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