...He already said in the initial post that this was a problem with foot pedals, not abnormal gait or pain. We do not use our legs equally. It is entirely conceivable that he would crack a right rather than a left sole due to driving a stick. Machine operators get similar shoe wear problems.

The most important part of Medicine is listenning to the patient. It gives you 85% of the differential diagnosis.

Yes, all those other thing can happen. Yes, they are serious. That being said, they are rare. You did not listen to the patient's main complaint, so you are about to do a million dollar work-up on a guy who did not seek medical advice and just wanted better shoes. I appreciate your zeal, but if these are your concerns you might as well do a total body MRI on this gentleman who really had no other complaints. I just don't get it. (And this is coming from a guy who takes no chances and works up everything to its conclusion-just look at my prior posts).

In other words, when you hear hoof beats, think horses, not zebras.

P.S. metachromatic leukodystrophy - rare and in adults most likely would present with dementia. It is genetic so most likely there would be a family history. Are you saying CmacD is demented?


motor neuropathy - There are thousands. Bottom line is the patient is not complaining of ambulation problems. It is possible, but listen to what he says 'but every pair of work boots, hiking boots or dress shoes that I wear and drive with on a regular basis I break the sole right across the ball of my foot'. Hence, only the stuff he drives with.

Charcot Marie Tooth - bilateral usually. Presents with abnormal arches clawed toes and thin calves and high arches. Possible but also rare.

Tarsal coalition - in this age group would most likely present with pain. The treatment in an adult painless foot is LEAVE IT ALONE.

• Daddy needs a new pair of Shoes, CmacD, Mon, 5 Feb 2007 17:37:21
  • Re: Daddy, do you kneel down a lot?, Robert Rightmyer, Tue, 6 Feb 2007 13:20:17
  • THANKS!!, CmacD, Tue, 6 Feb 2007 05:38:21
    • Garmont Eclipse XCR, AMG , Tue, 6 Feb 2007 08:16:41
  • Adidas Gazelle sneakers, JMJ in NC, Tue, 6 Feb 2007 05:24:58
  • Re: Daddy needs a new pair of Shoes, Noel, Tue, 6 Feb 2007 05:03:42
  • See an Orthopedic Surgeon.., AlS, Mon, 5 Feb 2007 21:37:31
    • Interesting..., CmacD, Tue, 6 Feb 2007 05:36:16
    • Why, if there is no pain?..., Chaz, Tue, 6 Feb 2007 01:30:38
      • Brain tumor, Multiple sclerosis, spinal cord tumor,..., AlS, Tue, 6 Feb 2007 07:25:24
        • AIS, good zeal but you did not listen to the patient..., Chaz, Tue, 6 Feb 2007 11:20:10 <-- Viewing This Message
        • What the...., Tito, Tue, 6 Feb 2007 08:33:30
          • A1S is right..., Erik919kt, Tue, 6 Feb 2007 08:51:07
            • A bit more intel..., CmacD, Tue, 6 Feb 2007 10:28:27
              • I would recommend..., Erik919kt, Tue, 6 Feb 2007 12:13:23
  • I would bet, PT, Mon, 5 Feb 2007 18:49:59
  • Re: Daddy needs a new pair of Shoes, Randy Thatcher , Mon, 5 Feb 2007 18:30:18
    • WRX with metal pedals n/m, CmacD, Tue, 6 Feb 2007 05:33:49
  • Re: Daddy needs a new pair of Shoes, jp, Mon, 5 Feb 2007 18:02:09
    • Yes, I think the matching revs it the killer... N/M, CmacD, Tue, 6 Feb 2007 05:34:45

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