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Posted March 14, 2025KNEE AND HEEL PAIN IN ADULTS
Case Study: A 55-Year-Old Female with Right Knee and Heel Pain, Hyperlipidemia, and Mild Anemia
Chief Complaint
Right knee pain and right heel pain for 3 months.
History of Present Illness
A 55-year-old woman presents for an annual physical and review of laboratory tests. She reports insidious-onset right knee and heel pain, worse with prolonged standing and morning stiffness lasting less than 30 minutes. There is no history of trauma, swelling, or erythema. Pain improves with rest. She denies fever, weight loss, or systemic symptoms. Review of systems is negative for headache, chest pain, dyspnea, or syncope.
Past Medical History
Hyperlipidemia (newly identified)
No prior surgeries or chronic conditions
Medications: None
Allergies: NKDA
Social History: Sedentary office job, non-smoker, occasional alcohol use
Physical Examination
Vitals: BP 122/67 mmHg, Pulse 63 bpm, Resp 16/min, BMI 26.18 (overweight)
Musculoskeletal:
Right Knee: Tenderness over medial joint line, no effusion, full range of motion
Right Heel: Tenderness at plantar fascia insertion, pain on passive dorsiflexion
Diagnostic Studies
Test Result
Cholesterol 6.01 mmol/L (elevated)
HbA1c 5.35% (normal)
TSH 0.92 mIU/L (normal)
Hemoglobin 12.8 g/dL (low-normal)
Renal Function Urea 4.5 mmol/L, Creatinine 74.5 µmol/L (normal)
Echocardiogram Normal aortic valve
Assessment/Differential Diagnoses
Right Knee Pain:
Primary: Osteoarthritis (age, BMI, localized tenderness)
Secondary: Meniscal injury, patellofemoral syndrome
Right Heel Pain:
Primary: Plantar fasciitis
Secondary: Achilles tendinopathy, calcaneal spur
Hyperlipidemia: Elevated LDL, increased cardiovascular risk
Mild Anemia: Likely iron-deficiency or anemia of chronic disease
Management Plan
Diagnostic Workup:
Imaging: Right knee X-ray (weight-bearing), heel ultrasound/X-ray
Labs: Iron studies, ESR, CRP, serum uric acid
Hyperlipidemia: Lifestyle modifications (diet, exercise, weight loss) ± statin therapy
Pain Management: NSAIDs, physical therapy, orthotics
Anemia: Investigate iron deficiency vs. chronic disease; consider supplementation
Referrals: Orthopedics, Podiatry, Dietitian
Follow-Up
Repeat lipid profile and CBC in 3 months
Reassess pain and functional status in 6 weeks
Discussion
This case illustrates the importance of a structured approach to musculoskeletal and metabolic complaints. Integration of imaging, laboratory analysis, and interdisciplinary referrals addresses both immediate symptoms and long-term health risks.
The unilateral pain pattern and elevated BMI suggest mechanical etiologies (OA, plantar fasciitis), but systemic causes (inflammatory arthritis, gout) must be excluded. Addressing hyperlipidemia and obesity reduces cardiovascular risk and may alleviate joint strain. Early intervention with lifestyle changes, targeted therapies, and patient education is critical to prevent chronic disability.
The patient’s complaints highlight the complexity of evaluating unilateral pain without trauma. Concurrently, her elevated cholesterol and borderline hemoglobin levels underscore the need for dual focus: symptom relief and long-term cardiovascular and hematologic risk mitigation.
Keywords: Osteoarthritis, Plantar Fasciitis, Hyperlipidemia, Anemia, Preventive Care
Prepared by: Dr. Abunyewa M.D M.B CH.B MSC MIS MACP MAAPM FAADA | Date: 14th March 2025