Heel Pain
Clinical Pearls of Wisdom Q&A CaseHeel pain is defined as physical discomfort on the back or the underside of the heel that may make walking uncomfortable or difficult. Heel pain can have causes that aren't due to underlying disease. Examples include poorly fitting shoes, wearing high heeled shoes, prolonged period on feet, overuse such as long walks or marathons, sprains, strains, or trauma.
Try this heel pain board review question-based case and pick up another "pearl of wisdom" from Med-Challenger.
Clinical Scenario:
A 48-year-old woman presents with right heel pain. She describes sharp heel pain that is bad in the morning, abates somewhat in the course of the day, and then returns by the end of the workday. It started insidiously and has progressed over the past three months. She does not recall any specific inciting injury.
She works as a picker in a warehouse and is on her feet during the workday. Her prior medical history includes hypertension, for which she takes amlodipine. Her prior surgical history is significant only for cesarean section. There is no family history of rheumatologic disorders.
On examination, her heel pain can be reproduced by firm palpation of the anteromedial heel. There is no edema, erythema or warmth.
Question:
What are the most appropriate next diagnostic / therapeutic steps for this patient with heel pain?
Answer Options:
Obtain a lateral foot x-ray, looking for calcaneal spur, and, if present, consider extracorporeal shock wave treatment.
Inject calcaneal tuberosity with dexamethasone and lidocaine, and use supportive taping.
Recommend rest, cushioned shoe inserts, home stretching exercises, and simple analgesics.
Order erythrocyte sedimentation rate (ESR), c-reactive protein (CRP), and an ultrasound.
See the Answer:
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