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Can anyone help me with this problem?

My patient, a lady in her 50's, full time carer for her severely autistic 15 year old son.

"I need some help with my feet. They ache terribly from the moment I wake up. I have had much abuse from doctors since I was a kid, but my feet really hurt and I need to do something about it now. My GP said he had referred me to Podiatry in the NHS but that was a year ago and I am fed up waiting. GP said there is nothing that can be done for the lipomas. Yes I do get pain in my neck after walking. Yes I do get a pain in my R/hip; I thought it was sciatica."

Patient seemed very upset and close to tears during whole of consultation. P/t seems in much pain and anticipated me hurting her. B/F 2-3 cpma.

Pain elicited: L/F ant lat mall and ant med mall and R/F ant and inf lat mall tumours; R/1 met pain along dorsum and plantar full length, post # in '06. Apparent LLD - L<R.
B/1 reduced dorsiflexion Gait showed abductory twist; reduced STJ eversion. tight TA.

Med history

Supra ventricular tachycardia
Med: Motropronalol
No relevant childhood illnesses.
R/tib and 1st met # 2006
Non smoker
Non drinker

PCO

Pain along full length of R/1 met on palpation,
Painful swellings around ankles
Sciatica; R/hip pain
Neck ache

On Examination

Gait: P/t seemed in pain walking; Abductory twist; XS F/Foot pronation

Exam: Reduced ROM at STJ, B/1mtpj; may have LLD although difficult to measure as obese.

L/F ant lat mall and ant med mall and R/F ant and inf lat mall palpable tumours (GP states lipomae) much pain elicited; could they be neuromae?

From her biomechanical anomalies, I feel she should go into bespoke orthoses asap, but should she consider surgery for removal of tumours, or are the insoles likely to improve the situation or worsen it?

I would appreciate any input towards this, my first posting on the site.

Many thanks

Jayne
:confused:

 

Jayne

Don't assume these are lipoma's. It sounds like something else to me, as they are typically asymptomatic. Consider such things as pigmented villondular synovitis or similar synovial conditions.

Get an MRI. Orthoses will not be the answer.

LL

 

Thanks LL

Will follow this thread through and let you know.

Regards

Jayne :)

 

I agree with LL; Perhaps these are not lipomas. Fatty deposits around the ankle, particularly the antereolateral, is very common and normally asymptomatic.
Ankle synovitis is incredibly common, and along with fatty desposits in the area, may be misdiagnosed as masses.
Given her multiple complaints perhaps R/O rheumatoid nodules.
Given what you have told us, I would first R/O a generalized inflammatory etiology. I often place patients on prednisone for a week and see their response. Sometimes it's quite remarkable.
Good Luck
Steve