Very fit female patient aged 52 presented yesterday with a 3 year history of pain in her right foot. Prior to the injury she was an avid runner - has not been able to since due to pain. She is unable to tolerate anti-inflammatories.
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Pain commenced while OS, after non-direct trauma in which she fell forward, "bending" (her description) the mid-tarsal joint. Pain was immediate.
On her return home one week later she consulted her GP & a Podiatrist, had x-rays and a CT scan which showed no abnormalities. She has 'tolerated' the pain since.
She has since experienced an aching pain 24/7. She occasionally has very short pain-free periods (minutes) which end with a sharp return of the same aching.
Pain is generalised throughout the foot, but with palpation was more focused at the dorsal mid-tarsal area around the BOM 2,3 articulations.
Her foot joints are generally "tight" in response to years of guarding and pain.
I have not sighted the earlier x-rays (she's bringing them on Monday) however I suspect she has had a Lisfranc joint dislocation which spontaneously reduced with attempted ambulation prior to radiographic assessment.
All references to Lisfranc Joint Injuries refer to treatments only within the first week - month after injury.
Does anyone have any experience treating an injury which has gone undiagnosed for 3 years?
Any alternative Differential diagnoses?
Is surgical fixation still a possibility after so long?
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