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A patient was recently seen complaining of acute intermittent foot pain throughout specific spots on his feet. At times debilitating, requiring narcotic medication. No biomechanical abnormalities were noted that would relate to these symptoms. His GP has done a full blood work up including HgA1C and uric acid. He has had an MRI which did not reveal any abnormality. Systemically, he has been told he has an over active immune system and has had testing done recently(results unknown). The location of his pain has been in various areas, not necessarily in joints ranging from the achilles insertion point, MTJ oblique joint, extensor retinaculum, between metatarsal shafts, 1st IPJ area............Any ideas?

 

? fibromyalgia (less likely)
? musculoskeletal manifestations of yet to be diagnosed systemic problem ?SLE
? enthesitis (ie seronegative spondyloarthropathy)
? diffuse idiopathic hyperostosis

really need results of "immune" testing

often not a lot can be done except drugs if systemic problem - needs monitoring for appearance of other symptoms --> diagnosis may then be obvious

 

Assuming that all blood work has been normal, could you please provide weight bearing X-Rays of his foot...specifically lateral and AP views?