Hello, I had a 15 year old girl in today presenting with pain and swelling in her right foot focussed in the area of her metatarsophalangeal joints (2-5). She explained that the injury occured 2 weeks ago whilst climbing slatted stairs at school, her toes got caught in a slat and she fell up the stairs. She was taken to A&E where she was x-rayed, no breaks were found. Swelling and bruising appeared quickly after the injury occurred. She was advised to take anti-inflammatories and to continue walking on the foot. She did this for 1 week, the pain got continually worse to the point that she is now no longer able to weightbear on that foot. She returned to her GP who advised Paracetamol and a thicker soled shoe.
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Now, 2 weeks later, my patient has been on borrowed crutches (borrowed from a friend) for 1 week to enable her to get to school as she feels she couldn't cope otherwise.
Her foot was extremely tender to touch in the area of the toes (2-5), 1st toe was tender but not as tender as the lateral 4 toes. The 2nd and 3rd toes were swollen with the 2nd being the most tender, most swollen and having brusing present. Pain dorsally was, as mentioned, over the metatarsophalangeal joints primarily extending to the midtarsal joint. Again, gentle palpation was extremely painful and there was swelling present over the afore mentioned areas. She also has pain in the plantar aspect of her foot extending as far as the metatarsal heads (2-5). She is unable to move her toes and any dorsal or plantar movements or inversion/eversion causes her a lot of pain.
She has asthma but no other health complaints. I am at a loss as to what to do to help her. She feels she has been 'written off' by her GP and the fact that her foot is so tender means I was unable to do very much for her today. Has anyone seen a similar injury? What helped? Any help would be very much appreciated. I hope that all makes sense!
ETA She has been icing twice daily for 10-15 minutes a time, resting with her foot elevated, using an anti-inflammatory gel and is keeping a tubigrip on her foot.
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