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  #1  
Old 07-18-2011
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Rheumatology/Orthopedics Heel pain

A 78 y old female presents with heel pain since 4-5 months duration. She complains pain increases with activity and decreases with rest. There is no h/o trauma. On examination Tinel's sign is negative and windlass test is positive, thompson test is negative. No muscle defect, mass or swelling is felt. What is most likely diagnosis?
1. Plantar fasciitis
2. Tarsal tunnel syndrome
3. Rupture of achillies tendon
4. Calcaneal bursitis
5. Rheumatoid arthritis
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Old 07-18-2011
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i think, 1. Plantar fasciitis
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Old 07-19-2011
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Can someone throw light on the tests done above ????
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Old 07-19-2011
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Quote:
Originally Posted by Lakshay View Post
Can someone throw light on the tests done above ????
Tinel test: For nerve entrapment,tingling checking i,e in nerve entrapment as in tarsal tunnel syn, carpal tunnel syn. Just tapping finger on medial malleolus and check for numbness and tingling. If increases indicate positive test.

Thompson test: To check achillies tendon tear. When patient lying in prone position, examiner applies slight squeezing pressure on gastrocnemeus muscle produce indirectly plantar flexion in achillies tendon tear..indicating positive test.

Windlass test: Done in wt bearing and non wt bearing position.
Examiner try to forcefully extend greater toe. If it produces pain medial calcaneal tubercle then it indicates positive for plantar fasciitis.
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Old 07-19-2011
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1. Plantar Fascitis.
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Old 07-19-2011
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Plantar fascitis......
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Old 07-20-2011
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Yes from above test mentioned we can rule out other potions easily and answer is 1. Plnatar fascitis.

2. Tarsal tunnel syndrome presents with numbness and tingling sensation and since tinels test is negative its not an option.

3. This option presents with gap on posterior heel palpation and as thopson test is negative its not an option.

4. Bursities present as swelling and pain, limited range of movement and due to positive windlass its not an option here...

5. Rheumatoid arthritis : Rheumatoid factor, morning stiffness, symmetric jt involvement etc are required to choose this as answer. So not a option here.
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