I've not posted on the forum before so please be gentle with me!
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An active, fit middle aged woman presented with heel pain that has been getting worse over several weeks.
There is no discomfort in the heel first thing in the morning or after rest.
The pain develops and intensifies with prolonged standing or walking. By the end of the day the heel is extremely painful. The pain is localised over the medial calcaneal tubercle where palpatation causes extreme discomfort and yes there is localised swelling.
At her first visit I referred her off for an X-ray and ultrasound and I did low dye strapping to attempt to offload the plantar fascia; this she found quite comfortable.
X-ray did not reveal the presence of a spur and/or fracture.
She didn't get an ultrasound as her GP advised against it as he thought it would only reveal inflammation (?)!
At her second visit I took a plaster cast in order to fabricate an orthotic to offload the plantar fascia. Structurally, she is hypermobile, she has a rearfoot varus and a very mobile plantarflexed 1st ray.
I'll be fitting the orthotics next week and I've also requested that she still get an ultrasound.
So what am I thinking?
Calcaneal nerve entrapment or a rupture of the attachment of abductor hallucis brevis.
I found that percussion of the Tibial nerve aggravates it a little, as does passively working the abductor hallucis.
Can anyone assist me with this?
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