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

Disclaimer & Credit: All medical articles including ours, are informative and provide population trends not specific to individuals which can be very different. Always seek personalized medical advice from your doctor for individual healthcare decisions.

Posted March 14, 2025