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10-year-old female presented to clinic for left heel pain and swelling. She participates in dance for an estimated 8-9 hours a week. Symptoms started four weeks prior to presentation. She does not remember any inciting event, fall, trauma, or other mechanism of injury prior to onset. She says the pain is localized to the lateral aspect of her calcaneus and extending up to her Achilles. She has never seen any bruising, erythema, or skin changes overlaying the swollen region. Family reports she intermittently has a limp. It is most tender to touch or when she bumps her foot on something. She continued to dance for the first two weeks, as she says her pain has not worsened with dancing. However, she has tried resting the last two weeks with no improvement in symptoms. She has no pain that wakes her up at night. She denies any numbness or tingling in her foot or toes. The case was discussed with Rheumatology who agreed with CRMO and recommended lab work and additional whole-body MRI. ESR was 15 and platelet count 65,000 while additional MRI showed multiple lesions throughout, including bilateral acetabula, superior/inferior pubic symphysis, right femoral neck, right tibia metaphysis, bilateral tibia epiphysis, right great toe, second and third metatarsals. With the lab work, MRI findings and absence of other type b symptoms, CRMO was the leading diagnosis. NSAIDs were started as the common first line treatment for pain control and disease modification.
Orthopedics | Pediatrics | Sports Medicine
Kral, Catharine and Harvey, Brian, "Insidious Ankle Swelling" (2023). Posters. 317.