I have a male patient, 50 years old, with heel pain of 4 months duration:
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Pain started 1 week after a stomping activity (farmer)
Has not got better or worse since it started to hurt
Very sore to press on (patient jumps) - very defined / localised spot
Sorest when on feet alot and when pressing on it
Can be sore when not on feet
Not sore on rising from periods of nonweightbearing
Location is about 10mm proximal and medial compared to the plantar medial calcaneal tubercle.
Xrays report 'no meaningful spur or bony abnormality' in the region though to me there appears to be two spurs in the traditional medial tubercle area. There doesn't seem to be anything significant on the plantar calcaneus.
There is no pain on palpation of the plantarfascia, ankle joint dorsiflexion is adequate, fatty padding is good and percussion of the medial calcaneus and around the painful area is negative.
I have issued 6mm bilateral heel raises with a 12mm hole cut out at the appropriate spot on the right foot (The aperture is so medial as to be right on the medial border of the heel raise). This has helped somewhat at this early stage, but he hasn't been on his feet much this week.
So I feel I have ruled out plantarfasciitis and medial calcaneal nerve entrapment. I thought a bursitis would be more in the middle of the plantar calcaneus.
Any ideas?
Regards
Rebecca
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