Colleagues,

i have an interesting patient with a 9 year history of bilateral medial,lateral and posterior heel none of which is truely plantar. He is an otherwise fit and well 54 yr old asian gentleman.

He stands with mildly pronated feet, has a hindfoot varus and normal ranges of motion and power in all his foot/ankle structures.

He suffers pain constantly and cannot tolerate sock pressure.

He has recieved cortisone injections, silicon heel pads, foot orthoses of various type's (9 in all!!), nightsplints, immobilsation in below knee POP's with heel cut outs for 8 weeks and numerous homemade and internet bought devices!

He has had MRI (nothing abnormal), Nerve conduction studies (normal), and a full blood screen (normal).

His pain is present throu! ghout the day and increases on activity restricting him to a maximum walking distance of 100m.  He suffers night pain also.

Visually he has obvious oedema around his medial, lateral and posterior aspects of his fatty pads.

He sleeps with his feet suspended in the air with 3 pillows.  He cannot tolerate pressure from his sheets.

Dynamic pressure studies show nothing remarkable.

My opinion is that he possibly has some bizarre form of allergic response to cotto/washing powder or some type of food?????

Any ideas/opinions welcome

Simon Dickinson ----------------------------------------------------------------- This message was distributed by the Podiatry JISCmail list server

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