Please Heel Me,I Can't Walk!

摘要

A previously healthy 20-year-old man presented to the emergency department with difficulty walking and bilateral heel pain. His pain started acutely in the right heel approximately 3 months prior to presentation with no known trauma or injury. He had previously been treated with steroids for presumed tendinitis and magnetic resonance imaging of his ankle showed a possible partial tear of the right Achilles tendon. His pain worsened and involved swelling of both heels so that he was unable to walk. On presentation, he had a normal neurological exam. His musculoskeletal exam was pertinent for pain over the calcaneus bilaterally and swelling with firmness over both Achilles tendons. Labs were notable for an elevated uric acid, and a computed tomographic scan of his feet showed the presence of monosodium urate crystal deposition, consistent with a diagnosis of gouty arthritis. Despite gout being a disease diagnosed almost exclusively in adults, pediatric providers must consider this and other diseases that typically affect adults, especially when treating patients at the older end of the pediatric spectrum. A previously healthy 20-year-old Middle Eastern male presented with his parents to our pediatric emergency department (ED) with complaints of bilateral heel pain causing inability to walk. Approximately 3 months prior to presentation, he had acute onset of right heel pain and right foot pain, without preceding injury. Pain was mostly in the right heel and worsened with deep pressure or walking. He was evaluated by his primary care provider who prescribed ibuprofen and gave him a “steroid shot”. A couple of weeks later, he went to an outside ED because of continued heel pain. There he was prescribed a steroid burst for presumed Achilles tendinitis and had temporary improvement of symptoms. The following month, heel pain returned, and he was evaluated by a podiatrist who thought his symptoms were consistent with an Achilles tendon tear after magnetic resonance imaging (MRI) revealed a possible partial tear.