I saw a 47 yo patient today with DM2. She was complaining of L heel pain for 1 month. She wakes up with pain and it is present all day long. There was no cracking, redness, warmth, etc. She had no history of trauma. She has had some minor symptoms of numbness in both feet. B DP 1+. Ankle reflexes 2+. LT and vibration intact B. I found a nice picture from uptodate submitted by Robert P Sheon, MD of a test to elicit plantar fasciitis pain. This maneuver - which involves grasping and dorsiflexing the toes with one hand while palpating the plantar foot with the other hand - did in fact elicit pain. I am also ordering plain films, but I thought that this was a nice and simple test to perform for diabetics with otherwise unexplained plantar or heel pain.
Follow-up:
ReplyDeleteBilateral heel views and complete foot x-rays showed mild calcaneal enthesophyte formation on the left at the insertion of the achilles tendon on the plantar fascia.