Haisook
Forum Junior
Topics: 12
Posts: 74
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A 22 year old medical student has been suffering from left foot ache and heaviness for 6 months. He says that probably the condition started by the time he had worn for sometime a new pair of shoes which are not as comfortable as his old pair. However, he stopped wearing them a week ago, but the condition won't lessen or go away.
Pain is elicited almost only on lying on bed. Although, the pain/heaviness is dull and diffuse in the foot (sometimes reaching up to the leg), lying on the back - where the heel presses on the bed - elicits the pain. Lying on his left side sometimes elicit the pain as well. He hasn't been able to sleep in those 2 positions ever since he got the condition. So, he sleeps on his right side. Another trigger for the pain is pressing of the middle of the sole on a prominent object (like a step edge or a chair leg).
On sitting, he only feels very dull and diffuse heaviness in the left foot and leg. He never feels any pain during walking. He usually does not walk more than 30 min of time a day.
Plain x-ray imaging of the left foot is unremarkable. Clinical examination is unremarkable except for tenderness of the middle of the sole on pressing hard on it.
1. What is the next step to be done?
2. What is the most likely diagnosis?
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| Adam
Forum Senior
Topics: 6
Posts: 136
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Pes Planus ..
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| Haisook
Forum Junior
Topics: 12
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Hmm.. isn't Pes Planus supposed to cause discomfort on walking for long distances?
The patient does not feel any pain during walking.
But may be I'm wrong.
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| RX 135
tormenta
Topics: 23
Posts: 525
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plantar fascitis in medical student...can it be Beaugers
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| Korotkoff
Forum Senior
Topics: 15
Posts: 178
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There is something called TARSAL TUNNEL SYNDROME. The pain and numbness is worse at night.
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| RX 135
tormenta
Topics: 23
Posts: 525
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“People don't change. For example, I'm gonna keep on repeating 'people don't change.' ”
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| Haisook
Forum Junior
Topics: 12
Posts: 74
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Could be plantar fascitis if the patient is really obese and works a lot. Also, it is very painful particularly in the early morning steps. This was not mentioned, so it's less likely to be the diagnosis here.
Tarsal tunnel syndrome typically presents with numbness or tingling and pain that is releived by rest. The patient here does not move around a lot and gets the pain especially on rest. Plus, Tinel sign is not given a mention here which should be positive if the tibial nerve is really affected.
I don't know. It could be an "atypical" Pes Planus given the new shoes thing and the rest-associated pain. There was no mention of a flat foot in the clinical examination.
So if we assume it's Pes Planus or plantar fascitis, what's the best next diagnostic test to be provided to the patient?
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-- USMLE-preparing med student from Egypt ---- My medical website: Medicopedia - the medical show!
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| Haisook
Forum Junior
Topics: 12
Posts: 74
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Could it be any kind of tumor?
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| docnikki
Forum Guru
Topics: 93
Posts: 680
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i think its plantar fascitis give the Rest pain and tenderness in the middle of the sole on pressing it, pain goes away on walking.
But I dont understand why it comes up in the leg sometimes while lying on the back or left side...why these 2 positions aggravate the pain...could be some nerve being pressed in the spine?
very tricky!
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