Master the board step 3

Rheumatology
Treatment
Treat with bisphosphonates and calcitonin.
Baker’s Cyst
A Baker’s cyst is a posterior herniation of the synovium of the knee. Look for
a patient with osteoarthritis or rheumatoid arthritis with a swollen calf. A
ruptured Baker’s cyst is a “pseudo-phlebitis.” Unruptured cysts can be palpated.
Diagnostic Testing
Exclude a deep vein thrombosis with ultrasound.
Treatment
Treat with NSAIDs and, occasionally, with steroid injection.
Plantar Fasciitis and Tarsal Tunnel Syndrome
The following table compares these 2 conditions.
Plantar Fasciitis
Tarsal Tunnel Syndrome
Pain on bottom of foot
Pain on bottom of foot
Do not order a foot x-ray
for plantar fasciitis or tarsal
tunnel syndrome. Heel
spurs make no difference.
Very severe in the morning, better
with walking a few steps
Stretch the foot and calf
Resolves spontaneously over time
More painful with more use; like
carpal tunnel of the foot; may have
numbness of the sole, too
Avoid boots and high heels; may need
steroid injection
May need surgical release
Morton Neuroma
This condition presents with the following:
··
Painful burning sensation in the interdigital web space between the 3rd
and 4th toes
··
Tenderness when pressure is applied between the heads of the 3rd and 4th
metatarsals
··
Sharp, intermittent pain radiating into the toes that feels better when shoes
are taken off
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