Plantar fasciitis or Hypo Phosphataemia Osteo-malacia

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Hi,

Apologies in advance for the long winded history. As you have all been so helpful previously I thought I'd pick your brains again..

I have been treating a lovely lady with 'plantar fasciitis' with absolutely no success. This lady initially hobled into my clinic in Oct 2010, was very tearful and in extreme pain. She could barely partially weight bear as the pain was so extreme. She is 42 years old, slim build and previously led a normal active life. It is difficult to assess her accurately as we are limited by pain although I so far have not found any significant joint deformity.

A brief background..
Subdued, constant low level pain around plantar heel (she describes as both central and medial) of both feet began Jan 2010 at present for 6 months.

Mid-July, pain increased in both feet and by warly August the pain had become 'piercing'. During this time no injury was sustained and no obvious explanation for the increase in pain.

Orthopaedic consultant applied a steroid injection into 1 foot which instantly accelerated the pain.

By September she became wheelchair bound and slowly began to walk around the house in January 2011.

She is compliant with gentle stretches and the physio is treating her feet with regular ultrasound with no relief of symptoms.

She has consulted with various well regarded consultants: Orthopaedic, Metabolic and a Rheumatologist all of whom have discharged her as having plantar fasciitis.

Her mother suffers Hypo Phosphataemia Osteo-malacia, a hereditary condition within her family line. Other members of the family of this condition to varying degrees. Her mother is Hypo-Phosphataemic and it's believed her condition lies mainly in the kidney tubules.

The patient recieved a blood test to check phosphate balance at birth although test proved negative. However her mother tested negative for years before being diagnosed as her phosphate levels fluctuated widely.

I wonder if anybody has ever heard of something like this or has any idea how we can help her as ever other profession seem to have given up??!

Many Thanks

Mhairi F

 

Has an ultrasound been done to confirm the plantar fasciitis?

Musculoskeletal symptoms in hypophosphatemia are very uncommon (apart from the characteristic muscle weakness). However, there has been a case report of Hypophosphatemia and heel pain

 

As Craig asked but slightly different what images MRI or xrays have been taken ?

Got anything you can post up ?

 

Hello,

Not sure how helpful this will be. I have a seen a patient diagnosed with hypophosphataemia osteomalacia on a couple of occasions. She generally has very tender feet. She is very prone to fractures within her feet with no associated history of trauma. Has they been checked for a calcaneal stress fracture?

 

We have treated people with those symptoms and history very successfully with a Blake inverted heel device. We find that arch based devices lead to little to no change or even worsening pain levels with Plantar Fasciitis.

However, as previous posts have stated.. what does the imaging say?

 

Hi Everyone,

Thank you for your feedback. Sorry for the delay in my reply, I am waiting on the patient providing me with a copy of her MRI and X Rays.

I'll be back in touch shortly,

Thanks again,

Mhairi F