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Hi all,

a 55 year old gentleman attended with sudden onset of discomfort over the L/4 DIPJ 2 weeks ago; it can be 6-7 on a a scale of 1-10 (where 10 is the worst pain imaginable).
On mild meds for hypertension and cholesterol.
No previous history.
He works in the post office and can be on his feet for most of his shift both standing and walking. He looked at the toe and noted that it appeared red and swollen. He noted that it has kept him from sleeping on occasion.

O/E -
he appeared to have swelling over the DIPJ; no associated heat noted compared to other toes bilaterally. Looked like a bursa, but across the whole of the distal phalanx dorsally, creating a swelling over the proximal nail. (I have a picture but can't see how to upload it).
It was uncomfortable to palpate over the lateral aspect of the swelling, corresponding to the line of the joint.
There was no hardening of the skin over the swelling to indicate a mechanical cause, nor was there any wear within the shoe brought today.
In gait the toe wasn't under undue pressure re tight gastrocs / instability etc, if anything it didn't weightbear very much.

I really don't know what this might be. Any suggestions?

Many thanks in advance!

Joanne

 

? imaging
? stress fracture

 

Hi Craig,

It's certainly worth considering, but would you expect pain on palpation of the bone with that? Only the joint itself was tender (and not painful).

Also, do you use vibration to assess for stress fractures?

Joanne

 

Autoimune? RA, Psoriatic arthritis?

 

Gout?

 

Thank you folks. I'll have another look and see what aligns most closely.

 

Can you share the results that will be obtained?