Is there any family history?
Have a read of:
Kim CW, Shea K & Chambers HG. (1999) Heel Pain in Children. Journal of the
American Podiatric Medical Association. Vol. 89 (2), pp. 67 - 74.
-----Original Message-----
From: Steve and Meiling Day [mailto:[log in to unmask]]
Sent: 03 September 2003 11:11
To: [log in to unmask]
Subject: challenging heel complaint
Hi All,
I have recently seen a young lass who has presented with a difficult
scenario of heel pathology that is proving a challenge to diagnose and
resolve. Was hoping that someone might have some ideas?
The lass involved is 12 years of age and was initially complaining of a
painful left ankle for 3 to 4 months duration. She actively participates in
netball, cross country running and general phys ed at school. She has sound
footwear and her netball shoes are ideal. Her symptoms have slowly reduced
in her left ankle, and now she has developed plantar heel pain bilaterally,
which originated again on the left side. This has limited her activity,
and nhence prompted her to seek podiatric help. A previous course of
physiotherapy involving ultrasound has not helped.
She presented on her first visit with oedematous swelling on the medial
lower left ankle, and considerable swelling on the plantar/medial surface of
the heel. The swelling was also present on the right heel, though not as
severe. The areas were not hot or redened. There is no history of trauma to
the area, and no history of any distinct injury. The swelling was painful
to gentle palpation, and pain was also increased with plantarflexion and
inversion against force.
The foot itself is very hypermobile with a mild forefoot supinatus, though
could not observe her gait due to her hobbling limp.
I initially strapped the foot to limit her pronation, however with the
swelling this only increased her symptoms of pain at the heels.
I have sent her for xrays which did not show any abnormalilty. Suspecting
soft tissue injury I also sent her for a soft tissue ultrasound, which
showed no signs of inflammation, tenosynovitis, ganglions, cysts, tendonitis
or soft tissue ruptures. There is also no bursitis. The ultrasound only
showed the swelling as a "mixture of subcutaneous fat and normal short
muscle groups of the foot". This only leaves me to think that she may have
a fat pad pathology, though I have not come accross this before.
I have also asked the lass to refrain from sport for a period of three
weeks. This has reduced symptoms minimally, though has not reduced the
swelling.
She would be a good candidate for orthoses, though at present the amounts of
swelling and pain are exacerbated by controlling her foot. MY next train of
thought would be silicone heel cups or tulli's cups. I'm hoping this will
improve her symptoms!
Has anyone else here experienced anything similar?
Would appreciate any experiences.
Thenks,
Mei
Steve and Mei-Ling
IT Support and Podiatrist
' We 'll fix your computer and feet :) ! '
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