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First post + clinical question on strange foot pain

Discussion in 'Introductions' started by Alison_D, Nov 4, 2010.

  1. Alison_D

    Alison_D Member

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    Hi, this is my first post on podiatry arena - looking for some advice on a new patient I saw today!

    78year old woman presented complaining of “intense” pain in her feet. This pain has been present 18 months, and is painful during walking, whilst standing and during rest. Up to 8 or 8 out of 10 on VAP scale
    Bilateral - L worse than R

    She has no history of fractures.

    She reports no diabetes (yet to be confirmed with fasting glucose test)
    She does however has a history of an “unknown virus” affecting her 10 years, following an illness with glandular fever, and a trip to the Northern Territory.

    This was suspected, as ruled out as being Malaria, Dengue Fever and Legionnaire’s Disease. It was also suspected to be something along the lines of bird flu.

    She experienced surging temperatures, which would peak (at unknown temperature) and leave her with violent shaking of her whole body); followed by temperature plunges.

    By her account, she was not treated with medications or antibiotics.

    Recent x-rays indicate Charcot neuroarthopathy.
    Pain is greatest with active/passive dorsiflexion with and without resistance. Jack's test is painful to assess.
    Most painful point of gait cycle is end of midstance/early toe-off.
    Feet are not red or hot. Nil temperature difference.
    Swelling noted L > R

    I am organising for a fasting glucose test to rule out diabetes. Thinking aetiology of Charcot may be something to do with this virus? or undiagnosed lupus??
    Trialling low dye strapping (rearfoot eversion and midfoot collapse noted in gait) also trying 4mm bilateral heel raises to reduce pain during dorsiflexion in gait.
    Considering adding rocker-soles to her footwear (Brooks Addiction) to aid propulsion.

    Anyone seen anything like this or have any advice???


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