First proper post, be gentle.
Members do not see these Ads. Sign Up.
CC: A 38 y/o female with a 4week history of pain in her right dorsolateral foot around base of 5th met.
HPI: Pt is slightly overweight. Works full time but not on feet much. Pain is worse in evening when she is on her feet more around the house. Recently had been ramping up physical activity with boot camps and running up to 5km. Has had to stop due to this foot pain. No recolleciton of any trauma, symptoms came on slowly and are getting worse. L foot no pain. No difference in pain between different shoes or when in barefeet.
Hx of plantar fasciitis resolved by another pod with orthoitcs (did not bring in to consult so I have not seen them but I understand them to be 8deg mod root)
PE: No pain when palpating distal 5th met, med mal, peroneas brev/long.
Very painful to palpate styloid process and severe pain in joint space between styloid and cuboid. The peroneals are pain free even right at the insertion.
Musculoskeletal:
Gait examination: Moderate pronation through midstance however gait is affected by limping due to the pain.
Neurological: WNL
Dermatological:WNL
Vascular: WNL
Tests: X-ray attatched - no sign of any fractures.
Diagnosis:
To me the styloid process itself appears elongated compared to most other people and is wraps around the cuboid more than usual. The proximal edge of the joint space appears narrow and there is some slight cloudyness in the ocntrast (may not be clear in photos). I suspect the pain is due to the unusual shape of the styloid process combined with footwear and increase in activity causing a pinching at the proximal joint space of the cuboid.
Treatment Plan:
Pt only had worn flats today not conducive to padding. Bringing in shoes this evening to try and combine padding and strapping to relieve pain.
Tried cam walker but as suspected there was no effect on pain. My concern is that this may be a surgical case if my suspicions of the cause are correct.
I appeal to the collective knowledge of my much more experianced and informed peers. It may be that I am way off here and am just looking at the result of an inflamed bursitis.
Loading...
- Similar Threads - Styloid pain fracture
-
- Replies:
- 0
- Views:
- 4,412
-
- Replies:
- 22
- Views:
- 25,692
-
- Replies:
- 1
- Views:
- 9,359
-
- Replies:
- 7
- Views:
- 15,639
-
- Replies:
- 5
- Views:
- 6,473
-
- Replies:
- 9
- Views:
- 21,957
-
- Replies:
- 0
- Views:
- 4,999