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Old 05-05-2004, 16:50   #1
NousDefionsDoc
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Case BBR 549

S - 50 y/o WM, WDWN c/o "left heel hurts"X9 months after running on rocky road in jungle boots.

O - VS WNL, PERRLA, gait normal when walking-PT unable to run, no overt signs of trauma to (L) foot.
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Old 05-05-2004, 17:31   #2
shadowflyer
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I am thinking calcaneus spur or chip that only presents when shock of running occurs. Poss stress FX to area?

Any edema noted on exam? PMS intact? Full range of motion?


Fire away gentleman.
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Old 05-05-2004, 17:34   #3
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Quote:
Any edema noted on exam? PMS intact? Full range of motion?
No, Yes, Yes
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Old 05-05-2004, 18:03   #4
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Ok, No edema and PMS and Range of Motion intact.

SAMPLE/OPQSRT

Focused Physical Exam based on CC and HX.

Normal Gait , is there pain to palpation? Does it hurt when he walks but the pain is manageable to maintain a normal gait?


I am just trying to narrow this down.

Does the pain radiate at all? Does anything make it better or worse?
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Old 05-05-2004, 18:24   #5
Sacamuelas
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Discomfort upon palpation of area?

When standing on affected side is there pain in the back of the ankle when pushing off the ball of the foot ?

Last edited by Sacamuelas; 05-05-2004 at 19:59.
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Old 05-06-2004, 07:30   #6
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Minimal pain on palpation, but he is as tough as woodpecker lips - Old SAS, so hard to tell. Same when standing on affected side.

No edema. No radiation. Nothing makes it better - running makes it worse.
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Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

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Old 05-06-2004, 07:52   #7
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Well damn. I am going to drop back and research some more.
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Old 05-06-2004, 08:04   #8
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Originally posted by NousDefionsDoc
Minimal pain on palpation, but he is as tough as woodpecker lips - Old SAS, so hard to tell. Same when standing on affected side.

No edema. No radiation. Nothing makes it better - running makes it worse.
has he tried anything on his own to make it better? nonsterioidals like the motrin you all hand out like candy? where is the pain.... at the bottom of the heel? posteriorly along the tendon?

doc t.
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Old 05-06-2004, 08:18   #9
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Quote:
has he tried anything on his own to make it better? nonsterioidals like the motrin you all hand out like candy? where is the pain.... at the bottom of the heel? posteriorly along the tendon?
He is not running, and that is what worries me. When a man that hard stops an activity on his own due to pain....

I have him on SF Candy - 800mg TID for unrelated Old Dude Syndrome in his knees. I'm hoping to get some collateral benefit for the foot problem.

Pain is on the bottom, about center of the heel. Seems to be a point almost. He didn't have any trouble showing me with one finger - went right to it. I was thinking tendon as well, but the geography doesn't fit. I tend to think he has a deep bruise from stepping down on a rock. The thing that bothers me is the time without improvement. Of course he hasn't been inactive all that time either, he's been walking and standing alot.

I've ordered him to change his footware as well.
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Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

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Old 05-06-2004, 08:43   #10
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Not to butt in here since I'm a medically challenged person but I do have the Old Dude Syndrome.

I get something that sounds similar. Localized pain, no color, swelling, but an intense pain in one spot. I've gotten it from stepping on a rock or something similar though it can happen from a sharp blow also. I get them on my arms and hands when sparring. Candy and not using the offended item usually makes the pain go away within 5 to 7 days. If I keep using it the pain stays the same.

Maybe it's age related? Lots of weird things start happening at this age.
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Old 05-06-2004, 08:53   #11
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All opinions welcome.
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Somewhere a True Believer is training to kill you. He is training with minimal food or water, in austere conditions, training day and night. The only thing clean on him is his weapon and he made his web gear. He doesn't worry about what workout to do - his ruck weighs what it weighs, his runs end when the enemy stops chasing him. This True Believer is not concerned about 'how hard it is;' he knows either he wins or dies. He doesn't go home at 17:00, he is home.
He knows only The Cause.

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Old 05-06-2004, 08:54   #12
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NDD,

You might suggest to him some Oregon Aerosoles. I have read about them and our Surgicalcric friend swears by them.


Just a suggestion.

Jason

here is the link

Oregon Aerosoles
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Old 05-06-2004, 09:30   #13
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Bone spur that has just now reared its head?

I would think if its pinpoint and in the center of the heel it would be either a chipped bone or a spur.

I would not think it would be a stone bruise, kyobanim, not with the elapsed time, but good guess.

Call for a portable X-ray...lol.
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Old 05-06-2004, 12:50   #14
Sacamuelas
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NDD-
If you have ruled out any posterior heel/achilles tendon etiologies.. then I, too, am thinking along the same lines as Cric. especially with your deescription of its exact location being on the plantar surface verses posterior heel along the tendon insertion.

My WAG:
O- plantar calcaneal spur (having that Xray Cric wants might be helpful )
Attached Images
File Type: jpg heel1.jpg (39.2 KB, 45 views)

Last edited by Sacamuelas; 05-06-2004 at 12:59.
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Old 05-06-2004, 12:56   #15
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another view...
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