Hi All,
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Not posted for a while but definitely need some help with this patient!
It's embarrassing to admit that in all the time that I have been practising (4 years) I have never really seen a stress fracture first hand, only the ones that have been diagnosed and had treatments put in place and we are following up on etc or who are coming back with a new complaint and it's in their medical hx.
I had a gentleman attend my walk in clinic last week with severe pain in his right 3rd met, he has no hx of injury but does work long hours as a waiter, this pain has been going on for 4 weeks and is getting worse, he reports that his GP has been 'fobbing him off' with antibiotics and telling him that basically it is all in his head.
On examination there is so me localised inflammation to the region of the 2nd and 3rd mets and pain can be ellicited on palpation of the shaft of the 3rd met just proximal to the MTPJ, HOWEVER, this pain is not there all the time, if I talk to him and distract him and push on the same area there is no pain but when he feels that pain should come he is in agony (hope that makes sense) He is not sensitive to the tuning fork as you may expect a fracture to be.
He is limping (this could be a selective limp when he knows he's going to see a medical professional as he walked in with it but not out with it)
We have not had the X-RAYS back yet but he wasn't x-rayed until I saw him in the 4th week of this injury.
I need some help as he is basically a very angry man who feels he has been fobbed off and is on the breaking point of thinking he is going insane with this foot (trust me no exageration)
Is this the typical presentation of a stress fracture or am I missing something blatantly obvious? Also how would you treat this?
If you need any more info please just ask I'm sure I've missed something out, I saw him last week and he is due back today
Thanks :drinks
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The effect of customised and sham foot orthoses on plantar pressures
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Important papers from the ACSM meeting
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The effect of customised and sham foot orthoses on plantar pressures
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Important papers from the ACSM meeting
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