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Michael Vibert January 10, 2018 at 10:04 pm.
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Michael Vibert
Patient came in today complaining of lateral calcanneal pain who I need some re-assurance and advice on please!
Pain location: Lateral and posterior calcaneal, been there about a month. Thinks it might have started after a weird sensation in her foot going up the stairs. Character: sharp when she first puts pressure on it but becomes more dull with further walking. She also has lower back pain and has been getting numbness and tingling in both lower legs. At worst it’s 10/10, average 3/10 (once it gets going)
Aggravating: Walking worst at first and warms up then gets worse again with too much walking, also walking on the beach. Sitting makes her back worse but not her legs or foot. Bending forward is also not provocative.
Relieving: Icing the foot. Wearing softer shoes. Rest.
Exam: Dorsiflexion was 2″ B but didn’t look like she was getting to her end range. This was because her legs got numbness and tingling. Lockout was weak. Palpation was tender but not exquisitely so over the lateral calcaneus, and the plantar fascia including the insertion.
Lower back: SLPF Toes with B Calf (no foot symptoms), SLR R57, L 73 both +Bragards. SHF was clean, KHE i didn’t perform, PKF was about 12″ R (surgical) and 6F Left. QLF was like 0% flexion
Neuro: DTr’s +2, Myo WNL’s (maybe hip flexor +4), Slumps +ve for foot pain, sensory was reduced lateral thigh, leg and foot.
Her problem is definitely a L5/S1 disc with radiculopathy right? It bothers me that her foot doesn’t get flared up with sitting, or bending over and that the first few steps being the worse sound very foot tendonotic-y to me. Although slumps was positive. Anyways I’ve sent her for a MRI and we’ll see the damage.
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