Hi all,
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I wondered if anyone could offer advice on the diagnosis of a patient I saw recently.
He presented with significant redness and swelling (no heat) around the left styloid process. The area was very swollen (including plantarly) and there was some discomfort on palpation (dorsal/laterally) but nothing excessive. Active and passive eversion was unremarkable.
He is in 60's and very active, he likes to 'push' himself when exercising. The pain occurs after exercise, he is fine during activity. He moderately overpronates and the size of his styloid process is assymmetrical when compared to his right foot.
There is no history of trauma, no systemic issues, he has had gout once in his 1st MPJ over a decade ago.
I applied low dye strapping to his foot which gave him good relief immediately and will be reviewing him next week. If there is no significant improvement I will consider referral for ultrasound and xray and to the GP to check for gout (very unlikely in surrounding joints I would have thought) and inflammatory arthritis/infection.
I have about 10 differential diagnoses in my head and I don't want to distract anyone from their inital thoughts by listing them so any ideas you have would be greatly appreciated.
Thank you in advance,
Amanda
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