I have a 32 female patient with mild osteoporosis due to long term prednisolone use present with acute heel pain yesterday. She is a nurse with many allied health friends (oh joy) that arrived with x-rays and in an oversized cam-walker. She has a very high pain tolerence threshold and a past history of fractures due to bone density. She has asthma and many allergies, all of which are being managed well.
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She had been getting dressed when she felt something snap in her left foot 7 days ago and since could not put her heel to the ground and had been toe walking since. On palpation she had no pain through ROM of the STJ or on plantar fascia ROM however was extremely painful on palp in the area of the medial calc tuberocity. The x-ray report was NAD however when we looked at it, it appeared as it there is a hairline fracture that is non-displaced, about 3mm in length at the medial tub of the calc.
At the moment I have got her into a more appropriate sized Cam Walker with the plan to continue this for the next 6 weeks however she has just rung me to tell me she got no sleep in the cam walker and can she just use an ankle brace a night. She is able to walk normal with minimal pain in the walker.
I am unsure with the management of fractures, especially in this part of the foot and if this is appropriate for night.
She is not working at the moment as she is nursing her palliative father so she needs to be alert and mobile so putting her in a cast or telling her to get used to it at night just isn't appropriate.
Would an afo at night help or just the splint or does this require further referral/managment? Any advice?
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