Diagnostic Dilemmas »
Pinpointing The Cause Of Posterior Ankle Pain
Chronic posterior ankle pain is a very difficult problem for foot and ankle surgeons. Given the multiple potential tendinous and osseous causes of pain, doing a proper diagnostic workup is essential for proper care. With this in mind, let’s consider the following case of a 52-year-old Caucasian male who presents with chronic pain and weakness of the posterior ankle.
A computer salesman with an avid love for golf and tennis, the patient plays tennis on the weekends and golf at least once a week for business. Approximately two months ago, while playing tennis, he began to feel pain in the
Diagnostic Dilemmas »
When Medial Foot Problems Have Lateral Symptoms
Lateral foot pain may be associated with problems of the lateral or medial foot. Often, if there is a problem on the medial aspect of the foot, your patient may also note that he or she has had long-term pain on the lateral aspect of the foot and ankle. Here is a common finding I see in my practice that may help you diagnose and treat lateral foot pain.
A 58-year-old female has chronic pain in the lateral aspect of her right foot. She has had the pain for six months and says it has been getting worse in the past one to two months. She recently increased her level of activity with more charity
Diagnostic Dilemmas »
When Achilles Tendonitis Is Not Caused By A Tight Achilles
A patient comes into the office with an aching sensation in the posterior aspect of the right leg. He notes the pain has been increasing in the past two to three months and has gotten worse since he began to exercise. Specifically, in the past three weeks, the patient says he has had tightness in the Achilles tendon region.
During that specific time period, the patient notes that he began a walking program on a slight hill by his house. He notes the hill provides a slight exertion that has been excellent for his stamina. The patient says he has only had the pain after a long climb and when h
Diagnostic Dilemmas »
Diagnosing Repeated Lower Extremity Ulcerations
A patient’s medical history can provide you with critical information that is necessary to differentiate among the various types of lower extremity ulcerations. Not only are there many different etiologies of lower extremity ulcers, it’s also important to be aware of the patient’s underlying medical conditions as well, as you will see in the following case study.
A 38-year-old Caucasian female patient recounted her underlying medical conditions when she came in for evaluation and treatment of her left leg ulceration. She injured the side of her leg while walking and had the ulceration f
Diagnostic Dilemmas »
Identifying A Dancer's Chronic Ankle Pain
A patient comes into the office with pain in the posterior aspect of her ankle. She doesn’t recall injuring the leg, but notes she has had the pain for over six months and that it is present at all times. An active dancer with the local ballet company, the patient adds that she experiences chronic pain when doing any form of dancing. She says the pain is far worse with high heels and ballet shoes en-pointe, but finds it more tolerable when wearing stable flat shoes.
The pain is deeper than the superficial Achilles tendon region and does not radiate to any region.
An examination of the pat
Diagnostic Dilemmas »
Identifying Skin Conditions Of Diabetic Patients
Many people with diabetes develop skin manifestations as a result of having the disease. In some instances, such skin problems may be the first sign that the patient has diabetes. Proper recognition is the key to successful treatment, but making the proper diagnosis can be difficult. Some conditions may have similar characteristics and presentations. With this in mind, test your diagnostic acumen with the following case.
A 64-year-old female with non-insulin-dependent diabetes mellitus came into the office with right and left leg ulcerations. The patient’s past medical history is significan
Diagnostic Dilemmas »
Diagnosing And Treating A Painful Tumor
Benign and bony outgrowths can be frequently misdiagnosed. With this mind, let us consider an unusual case involving a painful digital tumor that is gradually growing larger. Prior to presenting to our office, the patient had been evaluated by a couple of other physicians but the diagnosis had remained unclear.
The 19-year-old patient was an obese, non-diabetic female who had a chief complaint of a slowly enlarging painful tumor on the second left digit. She noted the lesion started approximately four months ago but recalled no trauma to this area.
The nodule, which had a reddish keratoti
Diagnostic Dilemmas »
Treating Severe Deformity In Young Patients With Rheumatoid Arthritis
A very difficult patient for me to treat is a young patient who has rheumatoid arthritis with severe deformity of the foot and ankle. This is typically a patient whose age may range from the late 20s to late 50s and is active except for his or her foot pain. With this in mind, let’s consider the following case study.
A 27-year-old female presented with a 12-year history of rheumatoid arthritis and extreme pain and deformity of the forefoot. While both feet are painful, she says the left foot is more severe than the right. The patient says the pain is in the region of the lateral fourth and
Diagnostic Dilemmas »
When A Blister Becomes An Ulcer: The Perils Of Insufficient Testing
There is a great deal of satisfaction when our diabetic foot care team gets referrals for patients who were previously seen by doctors from surrounding regions and other nations. However, there is also a great deal of difficulty with poorly or improperly managed cases. In this diagnostic dilemma, I’d like to focus on one patient who was sent to us after one year of care by several doctors.
The patient in question is a 70-year-old male, who was previously seen by two podiatrists and an orthopedist. His initial complaint was a small blister plantar to the first metatarsal head of his left f
Diagnostic Dilemmas »
Diagnosing Different Types Of Heel Ulcers
When a patient presents with an ulcer on the heel, one must perform an in-depth examination because distinctions among different types of ulcers can be subtle. Prompt, appropriate treatment is essential and it is also critical to assess predisposing risk factors and what can be done to help minimize these risks. With this in mind, let’s take a look at the following case study.
A 58-year-old Caucasian male had recently been hospitalized because he fell and broke his right hip. While he was in the hospital, the patient developed the condition on his right heel (as seen in the photo below). T
