ABSTRACT
Heel pain is 1 of the most common presentations to the foot surgeon, and its causes are multifactorial. Baxter's neuropathy is caused by an impingement of the inferior calcaneal nerve and has been reported to be responsible for up to 20% of heel pain. The diagnostic imaging features are striking, with inflammation or atrophy of the abductor digiti minimi muscle. Multiple studies have found that the prevalence of this finding is much greater than initially thought. However, it is more unusual to find bilateral and symmetrical features. The possible causes of this condition lie along the course of the inferior calcaneal nerve. Management is focused on treating the underlying condition, with conservative therapy and steroid injection as the mainstay. Refractory cases may require surgical release. We present the case of a 56-year-old female presenting with bilateral foot pain. Imaging reveals symmetrical abductor digiti minimi atrophy associated with bilateral plantar fasciitis. These appearances are well demonstrated on both magnetic resonance imaging and ultrasound.
Subject(s)
Fasciitis, Plantar/complications , Heel/innervation , Nerve Compression Syndromes/etiology , Fasciitis, Plantar/diagnostic imaging , Female , Foot/diagnostic imaging , Foot Diseases/diagnostic imaging , Foot Diseases/etiology , Humans , Middle Aged , Muscle, Skeletal/diagnostic imaging , Muscle, Skeletal/pathology , Nerve Compression Syndromes/diagnostic imaging , Pain/etiology , UltrasonographyABSTRACT
Protein-losing enteropathy due to massive mesenteric lymphadenopathy is a rare complication of Gaucher disease which is generally refractory to treatment with enzyme replacement and substrate reduction therapies. It is postulated that lymph nodes may act as a "sanctuary site" into which these treatments cannot penetrate. We present the case of a male child with Gaucher disease who developed massive mesenteric lymph nodes despite otherwise successful treatment with enzyme replacement therapy, and subsequently developed protein-losing enteropathy. The sonographic and magnetic resonance appearances of this complication are shown. Large volume lymphadenopathy inevitably provokes concern about the possibility of malignancy, but in a patient with Gaucher disease-particularly with significant ascites and clinical features of protein-losing enteropathy-this rare complication should be considered.
