Hi all - First time poster
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I'm a new podiatrist and have recently come across a case that has me stumped.
Patient Profile:
male, late 20's, tall and slightly overwieght - put on 20kg in the last year, work and uni involves standing for periods of time, does not do much exercise, young family
Foot profile: has a fairly flexible pes cavus foot type - one of the higher arches I have come across, wears shoes out quickly, has orthotics with the aim to help with shock absorption
symptoms:
1) over the last few months has had a slight case of plantar fasciitis, which has resolved with appropriate exercises and orthotics.
2) Secondly he has been experiencing an insidious dull aching pain at the base of the right 4th metatarsal - there has been no prior injury to this area, pain can be elicited by plantar palpation
- This dull pain comes about after a period of standing and at times forces him to have to rest to relieve the pain.
- Initial ultrasound imaging diagnosed a vascular effusion at the base of the 4th met which may be irritating the EDL tendon.
- After the orthotics were administered and appropriate activity modifications/icing etc, the pain slightly improved but is still irritating
- Through the GP he was booked to have the effusion fluid aspirated with an ultrasound guided injection, but this was abandoned during the procedure due to a lack of fluid and cortisone was injected instead
- since the cortisone sx's have improved by 30-40% but still a concern and affecting his ability to stand during uni placements. A subsequent ultrasound came back negative
- after the 2nd ultrasound results, I was thinking there could possibly be a stress reaction/fracture at the 4th base, but xrays came back negative (previous ct imagaing 3 weeks into the sx's were also negative).
- I recommended to go non weight bearing (cam walker) for the next two weeks and to review
Diagnosis??
So seeing recent ultrasounds and xrays have come back negative and the symptoms are still present, if anybody has an idea of a potential diagnosis and some experience in treatment that would be greatly appreciated.
Thanks kd
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