Ongoing calcaneal heel pain is significantly impacting quality of life. No diagnosis after 13 months. Please help.
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CC: A 31 y/o white male with around 10 months history of consistent, relatively sharp pain in the left calcaneus. Somewhat posterior and medial. 5'10" and 160 pounds.
HPI: Pain is made somewhat worse by weightbearing activities, oftentimes delayed hours to days following activity. Reducing weightbearing activities did not eliminate pain. Moderately sharp pain. Some tingling in medial calcaneus. No numbness. No strenuous physical activity has been performed since early 2015 but pain has remained. Painful to walk or stand still on feet. When weightbearing somewhat sharp pain is felt at the bottom of the calcaneus / calcaneal tuberosity. Pain is consistently better in the morning and gets worse through the day. Different styles of shoes have no effect on pain. OTC NSAIDs have minimal effect on pain. Treatment with over-the-counter orthoses have been of little relief. Four months of physiotherapy including deep tissue massage and ultrasound were of little relief. Attempted to treat issue with walking boot for 6 weeks. No improvement. Primary diagnosis of postalcaneal bursitis along with Haglund's deformity from orthopedic surgeon. Left calcaneus resection surgery underwent in late June 2015 followed by six weeks in walking boot. No material improvement. Physical therapy, low inflammation diets, and rest until January of 2017. Saw a doctor who noted that the plantar fascia is in good shape and diagnosed tarsal tunnel and recommended PRP to fix torn ligaments and tendons from multiple ankle sprains dating back to a high ankle sprain in high school. Underwent a PRP treatment three weeks ago. No change at this time. Saw a physiatrist who did EMG testing and ruled out tarsal tunnel. Suggested gabapentin for neuritis.
PMH: Overall exceptionally healthy. High left ankle sprain in high school and then multiple (~12) left ankle sprains over the next ~12 years. Torn right ACL due to trampolining in 2010.
PE: No swelling or redness. Sensitivity to touch in the medial calcaneal area. Full strength in the leg and ankle. Have had no swelling or loss of strength for entirety of heel pain. Able to go on tiptoes without a problem. Dorsiflexion not a problem. When standing still on two fait, pain increases as weight is shifted from front of feet to back of feet. Pain felt in calcaneal tuberosity.
Musculoskeletal: Notably loose left ankle. Was diagnosed with functional hallux limitus, working on fixing this at physical therapy.
Gait examination: Overpronation and flat feet (never problems prior to injury in January 2015).
Neurological:
Dermatological:WNL
Vascular:
Tests: None available.
Diagnosis:
Treatment Plan:
Any help would be a huge relief. I can answer any follow-up questions, please let me know if there's anything I did not address in the information above.
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Falknors needling technique for verruca vulgaris: a case report.
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