Hi all
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I wanted to get some more ideas on whether I was on the right lines with a patient.
A 61 y/o female, overweight but tries to do 1-2 miles walk daily. Medication only levothyroxine and no other relevant history.
Onset of pain occurred several months ago with a sudden shooting pain in the right medial heel. There was nothing reported on an x-ray about his time. Over the interval between this and presenting it had become a more diffuse ache, but she had also developed numbness and tingling to her plantar lateral mid to forefoot and 2-5 digits. Perception to 10g monofilament was reduced and altered compared to left side.
History of numbness to 3 and 4 digits which preceded this.
Static stance maximally pronated STJ in rcsp
O/e med deviated STJ axis. Pain on palpation med calcaneal tubercle and peroneus longus insertion and some discomfort over course of p.l.
Non painful areas of oedema lateral foot and ankle overlying peroneal tendons and plantar metatarsal area.
OA at knee worse on right side and marked tenderness over MCL insertion
Gait- Apropulsive with med roll off
Footwear- thin soled and slip-on.
There is obviously multiple connected pathologies, but I'm slightly unhappy with the pattern of parethesia- does not seem quite right for Baxters etc connected with onset of heel pain., is unilateral so not hypothyroidism.
My best guess at moment is lateral plantar nerve entrapment combined with pre existing digital nerve irritation.
She's has had advice on footwear and we'll try some orthotics with rear foot med skive and pad just proximal to 2-4 met heads
Any comments welcome!
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In-Shoe Pressure Measurement and Foot Orthosis Research
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Comparative Biomechanical Effectiveness of Over-The-Counter Devices for Individuals With a Flexible
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In-Shoe Pressure Measurement and Foot Orthosis Research
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Comparative Biomechanical Effectiveness of Over-The-Counter Devices for Individuals With a Flexible
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