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xx Foot & Ankle Disorders in Lyme
« Thread started on: Aug 18th, 2005, 10:24am »

Foot & Ankle Disorders in Lyme

author: Jason Faller, M.D.,
Francesca Thompson, M.D., and William Hamilton, M.D. New York, New York


Foot And Ankle Disorders Resulting From Lyme Disease

abstract: Ten cases of Lyme disease involving the foot and ankle are reported. Onset of symptoms was months to years before diagnosis. A variety of clinical foot and ankle problems resulted. Careful case histories and serologic testing resulted in proper diagnosis and treatment.

Introduction "First recognized in 1975, (7) Lyme disease is now the most prevalent arthropod borne infection in the United States......

Late stages of Lyme disease may cause persistent musculoskeletal symptoms. When seen in the context of a systemic disease with a history of tick bite or characteristic erythema migrans (ECM) rash, the diagnosis is straightforward.

Cases presenting solely with musculoskeletal manifestations may RESEMBLE AN OVERUSE SYNDROME, tendinitis, or a mechanical derangement of
the joint. "We summarize herein 10 cases of Lyme disease with involvement primarily of the foot and ankle. Such cases commonly seek care from the orthopedic surgeon or podiatrist.

Clinical awareness on the part of these specialists can result in appropriate diagnosis.

Methods Patient Population "The patients presented to a referral rheumatology practice in Manhattan, New York, from August 1987 through January 1990. during that period a total of 25 patients with Lyme disease were diagnosed. Six of the 10 reposted here were referred from a large foot and ankle orthopedic practice (E.T. and W.H.), which sees 2500 new patients annually. "

All patients underwent a thorough history and physical examination. Patients were questioned in detail regarding any history of tick bites, erythem chronica migrans rashes [bull's eye rashes] , exposure to known endemic areas for Lyme disease, and outdoor activities. ...........

Results "Case histories are summarized in Table 1. Patients ranged in age from 18 to 66 years. .....

Symptoms were present from 6 weeks to 6 years prior to diagnosis. The presenting or predominant foot
and ankle symptoms are listed. "Only two of the 10 cases recalled a tick bite. One of these individuals recalled an ECM rash. However, the remaining eight cases all had outdoor exposure to endemic areas for Lyme disease. S

ix cases gave a history of leisure time spent outdoors on the southern shoreline communities of Long Island, New York.

Five of these six were in Suffolk County, New York. Case 7 was from Bronxville, Westchester County, New York. Case 10 has spent time in both these endemic areas as
well as Connecticut. Case 1 had enjoyed running in the woods at his home in Mendon, New Jersey. Case 9 had a bite and ensuing ECM rash while vacationing at a game preserve in Texas in 1985.

[some info from table 1- duration of symptoms prior to
diagnosis predominant symptoms
1 left posterior tibial tendinitis 16 months

2 right ankle swelling 2 years

3 bilateral subtalar joint pain 1 year

4 right subtalar joint pain 6 weeks

5 left dorsal foot swelling 2 months

6 bilateral plantar fasciitis 5 years

7 right achilles tendinitis 1 year

8 dysesthesias of insoles 6 years

9 bilateral heel pain 2 years

10 bilateral fist metatarsophalangeal pain 3 months]

"Table 2 lists physical findings prior to treatment
history and initial laboratory data.

Patient 1 underwent arthroscopy 1 year prior to
diagnosis. Patients 3 and 6 received steroid injections. Most patients had tried nonsteroidal anti-inflammatory medications.

[some info from table 2 case physical findings

1 tender left ankle

2 right ankle effusion

3 pain on subtalar motion bilaterally ' fibrositis ' trigger points

4 right lateral subtalar tenderness

5 diffuse swelling left dorsal foot and ankle

6 tenderness in heels, plantar fascia, tarsal tunnel, talonavicular

7 swollen right achilles tendon

8 decreased vibratory sensation in feet

9 numbness right great toe, bilateral heel tenderness, tender plantar fascia

10 tender first metatarsophalangeal joints
bilaterally ]

"Case 3 had an associated fibrositis type syndrome. Case 8 described foot dysesthesias, including numbness, stiffness and a crawling sensation or tightness radiating into the calf muscles.....

"Most cases reported improvement with treatment.
[antibiotic] Cases 1, 2, 4, 5, and 7 had marked improvement or total resolution of symptoms...............

Discussion "Lyme disease is now a well-recognized cause of musculoskeletal syndromes. This spirochetal infection occurs in stages analogous to syphilis[1], and multisystem disease may ensue.

The disease-causing spirochete, Borrelia burgdorferi, is transmitted by a tick bite. Few individuals recall a tick bite, so that travel to an endemic area may be the ony historical clue.........

We have diagnosed a number of cases of Lyme disease in which the SOLE or presenting symptoms involved the ankle and foot.

Most of our patients gave NO clear-cut history of tick bite or ECM rash. Painful joints included tibiotalar, subtalar, talonavicular, and metatarsophalangeal.

Synovitis was not palpable in most cases. Heel pain, plantar fasciitis, Achilles tendinits, posterior tibial
tendinitis, and dorsal foot swelling were all seen. Unusual dysesthesias were also noted.

"Most of these cases were seen by podiatrists or orthopedists prior to diagnosis. Procedures including steroid injections, arthroscopy, and acupuncture were performed, al well as long courses of physical therapy and rest, without symptomatic response...........


"Lyme disease is increasing in incidence. We have described a number of cases with involvement primarily of the foot and ankle. Musculoskeletal syndromes due to this infectious agent can present and MASQUERADE for long periods of time as a structural derangement. A careful history and serologic testing for Lyme antibodies can result in correct diagnosis and appropriate antibiotic treatment....."
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xx Re: Foot & Ankle Disorders in Lyme
« Reply #1 on: Jun 11th, 2012, 04:11am »

Ten cases of Lyme disease relating to the foot and ankle are noted. Start of symptoms was months to years before diagnosis. A number of medical foot and ankle issues lead. Careful case backgrounds and serologic testing led to proper prognosis and therapy.
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