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Help/ info with Pt

Discussion in 'Biomechanics, Sports and Foot orthoses' started by cpoc103, May 28, 2010.

  1. cpoc103

    cpoc103 Active Member


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    I was wondering if anyone has come accross this before, or could shed some light?

    I have a 39yo male pt, no major medical HX, no family HX of any systemic conditions, works as a trades man/ tiler.

    CC- severe pain in all tarsal joints inc STJ and TCJ, also pain in MTPJs and PIPJs

    HPI- has had this pain for 6/12, started after he was on a job of tiling a flight of stairs where he needed to be kneeling/ bending forefoot a lot. No noted injuries. Pain is so severe he is walking with crutches and pain only present on weight bearing.

    PE- pain upon direct palpation of joints, pain upon plantarflexion of fore/ midfoot, and PF or dorsiF of digits. Also pain in major extensor and flexor tendons through inferior and superior retinacula and pain in left knee. No other body joints involeved.
    Gait Ax pt does not have gait, completely Apropulsive walking with crutches and taking very small strides, no flexion of midfoot or ankles.

    Diagnostic tests- pt has had Xray which was NAD, MRI which showed mild dengeneration in 1st MTJ and some midtarsal joints. Had bone nuclear scan which revealed oedema in bones extending to bone marrow. Seeing a rheumatologist but so far -ve for inflammatory markers. All foot joints R.O.M and Q.O.M limited, RCSP 1-2deg inverted at calc.

    Differ.. DX- I believe there is some sort of underlying inflammatory condition or possibly connective tissue problem??

    At present I have not made an orthoses in fear of aggrevating/ causing further problems, also due to inability to Ax Gait correctly.
    Have referred to physio to work on gait and balance/ rehab. Rh/A has presecribed sulfasalazine. My question is,- has anyone come accross anything like this before, and is there anything more I can do to try and make him more comfortable.

    Cheers

    Col.
     
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