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 examination and review of laboratory tests performed at Bank Hospital. She reports insidious-onset right knee pain and heel pain, worse with prolonged standing and morning stiffness lasting <30 minutes. No trauma, swelling, or erythema. Pain improves with rest. 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

Assessment/Differential Diagnoses

1. Right Knee Pain:
   • Primary: Osteoarthritis (OA) due to age, BMI, and localized tenderness.
   • Secondary: Meniscal injury or patellofemoral syndrome.
2. Right Heel Pain:
   • Primary: Plantar fasciitis (classic presentation).
   • Secondary: Achilles tendinopathy or calcaneal spur.
3. Hyperlipidemia: Elevated LDL contributing to cardiovascular risk.
4. Mild Anemia: Likely iron-deficiency or anemia of chronic disease.

Management Plan

• Diagnostic Workup:
  • Imaging: Right knee X-ray (weight-bearing) and 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 differential diagnosis, integrating imaging, laboratory analysis, and interdisciplinary referrals to address both immediate and preventive care needs. By prioritizing lifestyle modification, targeted pharmacotherapy, and patient education, the management plan aims to alleviate current symptoms while reducing future morbidity—a cornerstone of effective primary care in chronic disease management.

This case also highlights common musculoskeletal and metabolic issues in middle-aged women. The unilateral pain pattern and BMI suggest mechanical etiologies (OA, plantar fasciitis), but systemic causes (inflammatory arthritis, gout) must be excluded. Addressing hyperlipidemia and obesity is critical to reduce cardiovascular risk and alleviate joint strain. Early intervention with lifestyle changes and targeted therapies can prevent progression to chronic disability.

The patient’s complaints underscore the complexity of diagnosing unilateral pain in the absence of trauma, where systemic conditions (e.g., inflammatory arthritis, gout) must be ruled out alongside localized etiologies such as osteoarthritis or plantar fasciitis. Concurrently, her elevated cholesterol and borderline hemoglobin levels emphasize the need for a dual focus on symptom relief and long-term cardiovascular and hematologic risk mitigation.