A 47 year old lady presented to the clinic today with severe HDs, sub B/2nd and L/4th MPJS, with thick HK sub R/4th MPJ. These HDs are very deep and the size of a small pea (sorry for no exact dimensions)
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The patient has no medical history and these HDs presented only in the last 3years. There is a strong family history of RA with her mother and grandmother.
Her foot structure is unremarkable, only slight largening of her 1st MPJS, but nowhere near as severe enough to alter her biomechanics detrimentally to create such large HDs.
I have been unable to provide her with a reasonable explanation for the severity of these HDs. After seeing her today, I have considered taking Xrays however is that the right place to start or is this a simple case with a simple solution that I am overlooking?
Any feedback/advice would be greatly appreciated for the patient and also myself!!
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