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I have a middle aged woman who complains of burning pain dorsal R/foot. The pain has had a slow onset over several months, and is progressing. There is no mechanism of injury. The pain is not aggravated or alleviated with walking or rest, position of foot/leg, or footwear.
The pain is located proximal to the 3rd metatarsal head (approx 1cm) on the extensor tendon. The pain sometimes radiates out laterally.

There is no pain on flexion/extension of the third met, dorsiflexion or plantarflexion, or other resisted/passive movement. I can reproduce localised discomfort by applying pressure to the Extensor tendon in that one spot.

The patient has a history of a chronic wound apex 3rd met, however this was several years ago. No vascular problems noted.

The patient is beginning to get similar symptoms on the left foot.

Xray and ultrasound are both clear.

Any ideas???:wacko:

 

Unfortunately this doesn't seem to fit the symptoms. Any other ideas?

 

Alicia:

Have you tried percussing the superficial peroneal nerve at the anterior aspect of the ankle joint? Sometimes the nerve can become aggrevated due to osteophyte formation, tight footwear, oedema etc. Burning pain would also make me think that it could be something neurological.

Regards,

Daniel

 

Alicia:

Exactly how old is someone when they are "middle-aged"? Is there dorsal edema and is the tenderness on the 3rd metatarsal shaft? If it is, then it is likely a stress reaction (i.e pre-stress fracture) of the 3rd metatarsal shaft. Unless you can give us more information then it is unlikely that we will be able to help you or your patient.

 

Thanks guys, I am seeing the patient again this week and will try your suggestions. I'll let you know how it goes.

 

Hi Kevin:
Middle age = age at death/2

Steve

 

Steve, I like your thinking.