Case XX: Foot Pain

Department of Neurosurgery, University of Wisconsin, Madison, WI, USA


20.1 Case Presentation

A 50-year-old male complains of right foot pain for 2.5 months. He underwent endoscopic plantar fasciotomy 5 months ago. Following his foot surgery, his heel pain improved significantly, but 10 weeks later a new pain started. The new pain is in the arch of the foot and radiates distally. It is cramping and is rated 3/10 on the VAS . It improves with gabapentin and worsens with wearing shoes. PMH significant for borderline diabetes mellitus. On examination, he has normal strength and sensation in the right lower extremity. There is a Tinel’s sign over the right tarsal tunnel. Pulses are normal.

20.2 Questions

  1. 1.

    What is the differential diagnosis?


  2. 2.

    What studies do you need?


  3. 3.

    What do you recommend?



  1. 1.

    Foot pain could be caused by: plantar fasciitis, calcaneal spur, tarsal tunnel syndrome , peripheral neuropathy (diabetic or other), nerve injury from the first surgery, S1 radiculopathy , and ankle/foot deformities [1].


  2. 2.

    EMG / NCS : Increased latency and decreased amplitude of right tibial n (motor) at the ankle, and lateral plantar n (sensory), suggestive of tarsal tunnel syndrome . MRI right ankle and foot: negative for masses.


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Aug 29, 2017 | Posted by in ORTHOPEDIC | Comments Off on Case XX: Foot Pain

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