I have a question.. 58 year old male diabetic and hypertensive patient with rheumatoid arthritis on DMARDS, antihypertensives and oral hypoglycemic agents presents with pain in the right heel since one month.. insidious in onset, gradually progressing to a state where even keeping the foot on the ground in painful...
On examination tenderness present in the region.. pain not reducing even after analgesics..
X ray shows calcaneal spur.. physiotherapy taken for nearby four weeks.. but still no improvement.
Later patient also developed swelling and pain of the little toe..
patient consulted the Endocrinologist, orthopedician, physician, immunologist etc.. but still no improvement in the symptoms..
some said it is due to cellulitis.. gave antibiotics for nearly two weeks.. while others prescribed physiotherapy and analgesics..
what could be the diagnosis and treatment..??