Hi, was wondering if anyone could offer me some help!
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Patient is a 30 year old female, high level athlete (Age group Olympic distance triathlon world champion) in training for an iron man.
Patient presented with plantar calcaneal pain, after being told by 2 separate physio's it was plantar fasciitis, to rest and wear flat shoes (she was wearing dolly shoes and flip flops) she was wondering why the pain was getting worse despite the rest from running and stretching plantar fascia, icing etc as she was told to do.
Symptoms came on fairly insidiously, aching/bruised pain after a 10 mile run. There is no recollection of trauma, drastic change in mileage, uneven terrain.
Upon examination patient has tight gastrocnemius and soleus, moderate overpronation, rear foot varus, hypermobile forefoot. Most interesting (to me) was a palpable 'lump' to the plantar aspect of the calcaneus, which was fairly painful when pressure was applied to it. It feels firm/hard, doesn't appear to be mobile. Pain is unilateral and there is no pain upon palpation of medial tubercle of calcaneus or plantar fascia more distally.
Using Felt I applied a heel raise to an insole, with a cut out where the palpable lump was (total 10mm) , also added a d-filler (10mm) Patient reported this has helped alleviate the pain in trainers but still feels very sore barefoot. Patient still gets some dull aching in trainers with felt additions. In addition to this I have advised to carry on ice treatment and have used stirrup and low dye taping which again has helped with symptoms.
She has her ironman in 2 weeks time, im finding it difficult to diagnose (especially without further imaging) will running the ironman be a very bad idea?
Any ideas on potential diagnosis/ further treatments? She is getting an MRI after the ironman.
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