Hi everyone,
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I have recently had a seemingly obvious Severs case turn into something quite a bit more than that. After the initial consultation 7 weeks ago, the patients mother called this morning to let me know what's been going on and to ask for my advice.
S) 12 year old girl with right heel pain 1 month duration.
O) FPI +7 bilaterally; mildly everted halluces; supination resistance-very hard; limited ankle joint dorsiflexion; pain on palpation severs sites, nil elsewhere.
A) Diagnosed Severs
P) Issued with gastrocnemius and soleus stretches.
Telephone conversation today reveals that severe pain developed a week after seeing me and starting the stretches, at the back of the leg from the heel to the knee. It became so intense that the patient got crutches and has been using them out of necessity for 5 weeks now. There is severe hypersensitivity to touch around the heel region (can tolerate touch along the calf / achilles), and wearing shoes and weightbearing is not possible because of this hypersensitivity. Some relief is gained by keeping the foot elevated. Upon questioning, the skin is pale in appearance (assuming due to foot being elevated much of the time) and there are no other skin colour changes or sweating noticed.
Radiographs, ultrasound and bone scans performed 4 weeks ago were all negative - no hotspot on bone scan at all.
Interestingly, she fractured the right patella 10 months ago: non-traumatic.
So ....
It seems much more than severs or achilles tendinopathy / calf muscle tear. I'm coming up with fibromyalgia. No other areas of pain or sensitivity though. Her Doctor has up until now asked her to give it rest and time, though she does have another appointment this afternoon.
Any other thoughts or lines of enquiry? Thanks for your help!
Rebecca
Tags:
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Association of hypermobility and ingrown nails
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Lecturer or Senior Lecturer in Musculoskeletal Rehabilitation, GCU, Scotland
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<
Association of hypermobility and ingrown nails
|
Lecturer or Senior Lecturer in Musculoskeletal Rehabilitation, GCU, Scotland
>
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