Department of Neurosurgery, University of Wisconsin, Madison, WI, USA
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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.
What is the differential diagnosis?
What studies do you need?
What do you recommend?
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 .
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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