Dear Colleagues,
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I would very much value your opinion on the following case.
A 47 yrs old female patient presented at my office two weeks ago complaining of a great deal of pain in the sole of her left foot, several weeks duration.
On examination I found the plantar of the left foot (particularly 2-4 MPJt) area to be warm, swollen and tender on palpation. Mild bilateral HAV, left has been surgically corrected. No other obvious foot /ankle pathologies. Digital temp reading of the area indicates between 6/7 degrees centigrade temp differential between surrounding tissues and opposing limb. Patient not febrile. No signs of foreign body/ entry point / punctum / pus. No history of trauma.
Unremarkable social / medical history. Vascular and neurological status WNL. No medical history of note (other than c/o pain in right TMjt), patient not taking any medication. Pain score reported 7/10. Plays Golf regularly.
I arranged for x-rays and bloods (ESR, CRP, ANA, Double stranded DNA, Rh factor, serum uric acid). Advised the patient on ICE, pain relief and NSAID’s.
x-rays have come back showing no abnormalities other than mild HAV. Bloods have shown no inflammatory markers all WNL.
Any thoughts ladies and gentlemen? The temperature is still elevated and concerns me, my next thoughts are sonographic ultrasound?
Kind regards,
Kevin.
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