Heel pain
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Transcript of Heel pain
HEEL PAIN
Commonest of all causes
Achilles enthesitis Achilles tendinitis Achilles bursitis Plantar fascitis Calcanel spur Heel pad fat atrophy
Achilles bursitis
Plantar fascitis
Less commoner causes
Achilles tendon rupture Bone bruise Bone cyst Fracture Gout Neuroma Peripheral neuropathy Tarsel tunnel syndrome
Approach towards case
HISTORYCLINICAL EXAMINATION
INVESTIGATIONTREATMENT
HISTORY
PRESENITNG COMPLAINT1.ONSET-acute subacute insidious2.SITE OF MAX. INTENSITY AND
RADIATION OF PAIN3.REST PAIN-inflammatory pain
improves with activity
4.NIGHT PAIN-destructive Avascular necrosis Mutilating arthritis Malignancy5.MOVEMENT PAIN-use increases pain and rest decreases pain
6.PERSISTENT PAIN-bone pain
07.STIFFNESS;SENSATION OF TIGHTNESS-fluid distension of capsule,tenosynovium or bursa.In the morning ,stiffness increase and activity decrease due to clearing of fluid.
08.DURATION OF MORNING STIFFNESS
09.SWELLING-soft tissue,bony & fluid10.DEFORMITY-malalignment,subluxation or dislocation
11.DISABILITY-inadequate function12.PRECIPITATING FACTORS FOR JOINT
INVOLVEMENT –i)TRAUMA ii)INFECTION-
sorethroat, urethritis,
dysentry iii)STD iv)CONTACT WITH INFECTIOUS
DISEASE13.AGGRAVATING AND RELIEVING FACTORS-
rest,exercise,activity,imobility and drugs.
PAST HISTORY 1.TRAUMA 2.INFECTION-urethritis,dysentry 3.SIMILAR EPISODES-rheumatic fever, gout,palindromic rheumatism 4.h/o STD-secondary syphilis 5.CHARCOT JOINT TREATMENT HISTORY 1.Aspirin,NSAID,steroid,DMARD 2.SURGERY FAMILY HISTORY 1.Rheumatoid arthritis 2.osteoarthrosis,gout 3.Seronegetive spondyloarthropathies
GENERAL CLINICAL EXAMINATIONSKIN ERYTHEMA-JOINT:Septic arthritis, crystal
arthropathy,palindromic rheumatism. RASH-SLE,vasculitis,drugs PSORIASIS KERATODERMA BLENORRHAGICA-Reiters
syndrome MUCOSAL ULCERS-Behcet syndrome,SLE PYODERMA GANGRENOSUM-IBD PALMAR ERYTHEMA-Rheumatoid arthritis
PHOTOSENSITIVITY-development of rash on exposure to sunlight of less than 30 min.
SLE
SUB CUTANEOUS NODULES Rheumatoid arthritis,rheumatic fever Gout,sarcoidosis,SLE,hyperlipidemia
NAIL CHANGES CLUBBING-fibrosing alveolitis,hypertrophic
osteoarthropathy PITTING & ONYCHOLYSIS-Psoriasis SPLINTER HAEMORRHAGE-Small vessel
vasculitis,infective endocarditis.
MUCOUS MEMBRANE LESIONS Reactive arthropathy, Reiter’s syndrome,
Behcet’s syndrome,SLE DRYNESS-Sjogren’s syndrome
EYE CHANGES EPISCLERITIS & SCLERITIS-Rheumatoid arthritis IRITIS-Ankylosing spondylitis IRIDOCYCLITIS-Juvenile chronic arthritis CONJUCTIVITIS-Reiter’s syndrome SCLEROSING TENOSYNOVITIS OF SUPERIOR
OBLIQUE TENDON=BROWN’S SYNDROME-In Rheumatoid arthritis
LYMPHADENOPATHY Still’s disease, SLE
LOCAL CLINICAL EXAMINATIONMOVEMENTS ANKLE JOINT – 40 degree
dorsiflexion 50 degree plantar flexion
SUB TALAR JOINT-5 degree inversion 5 degree eversion
MID TARSL JOINT-30 degree inversion 30 degree eversion
LOOK FOR:1. SWELLING2. DEFORMITY
Hallux valgus and varusClawing of foot-Fixed flexion deformity due to small muscle wasting.Crowding of toesSausage deformity of toes -Psoriatic arthritis -Ankylosing spondylitis -Reiter’s disease
3. CALLOSITIES-On points of abnormal pressures
4. DAY LIGHT SIGN-Abnormal spreads of 2 adjacent toes
5. TENDOACHILLE’S PALPATION-Tendinitis, Rheumatoid nodules,Xanthoma
6. HEEL TENDERNESS-Plantar fascitis7. TENDINITIS-Tendo achille’s, Peroneal
tendon & Tibialis posterior tendon8. BURSITIS:Pre-Achilles and retro-
achilles
Calcaneal spur
TREATMENT
Rest or reduced activity avoid any barefoot walking
Foot and leg exercises Ice and Anti-inflammatories
Support your arches with orthotics
ORTHOTICS
THANK YOU