Hi Folks had a bit on interesting one today, need a little guidance and maybe a good discussion patient.
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60 year old Female patient.
Slightly overweight but in good General health.
Presented with chronic Right ankle pain both medial and lateral, feels internal as well and swelling.
Pain in the morning which gets worse on increased stress.
Hx 9-10 months ago lateral sprain of the ankle went to Dr rest, NSAIDS you will be fine.
1 month later still in pain but on holiday walking down some stairs missed a stair feel bodyweight on right foot pain in ankle, could not walk, very swollen. Fitted in a camwalker for trip home ??? ( I did ask how she walked in a cam walker if she could not walk - I won´t give you the answer)
Came home went to Dr (GP)who told her it is a bad sprain and because of your age it takes time to heal. A few days later in to ER given some NSIADS and go home, patient went back a couple of times, sent to another hospital - X-rays finally taken Diagnosed with a fracture ( Patient can´t remember which bone) but was told bone in to many fragments so surg fixation not an option, continue with Rest, camwalker etc.
Attached below are the latest X-rays I´m guessing Calc. fracture but there are bone fragments all over the shop.
Subtalar joint ROM reduced but Talocural joint compensates as does change in gait so patient can walk short distances.
Due to the talocural joint compensation pain in medial and lateral ligaments as well.
I will be completing a more detailed assessment in a couple of weeks.
In this patient I would try a total contact EVA device with Poron/PPT heel with a rocker shoe, but above patient is blind in one eye and has hearing issues and so has very, very bad balance and trying to walk in the camwalker she fell so Rocker soles are out. She also has other heal issues so crutches are a no go.
She has been told Surg treatment is not an option due to the bone fragments and the orthopedic was pleased with how well in healed and she should `get on with life`. He did say amputation was an option ??
There are many wholes in the patient history but sometimes the answer to the questions I asked had more info about the weather that day than anything else if you understand what I´m saying.
Any ideas ?
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