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I have a lady who fractured her proximal fifth phalanx 6 months ago. It has only begun to show signs of healing in the last 2 months. In the meantime, she has had severe pain which has begun to spread to the rest of the forefoot. The foot is cyanotic and slightly swollen still, with the skin quite shiny. Any suggestions other than taping?
Hazel

 

CRPS

cheers

 

I concur.

Take another look at the plain x-ray closely. Look for regionalised osteoporosis affecting the lateral aspect of the forefoot.

Get a bone scan, look for increased uptake in the blood pool phase as part of the sympathetic effects.

Try some serial sural nerve blocks + refer immediately for pain management consult, physiotherapy, guanethidine injections etc.

Read more here.

Good luck... :(

LL

 

Thanks guys, that's helpful.
Hazel.