Had a 75 y.o. man come in one month post injury after he jumped off truck tailgate and couldn't walk. Eval by vascular surgeon (daughter is his nurse) and orthopods without any firm diagnosis. Patient complained of "my foot slaps the floor, but not when I start to walk." Also related he now had a know on the front of his lower leg. He's in fairly good shape for 75 - or he wouldn't be jumping off truck tailgates.
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Exam showed a firm nodule at distal anteromedial leg without pain and no TA tendon visible on attempted dorsiflexion as compared to right foot. Forefoot in eversion to rearfoot. Foot doesn't slap floor initially when walking, but progressively contacts floor more forcefully after a few minutes of walking. Has not resulted in any falls.
Due to the patient's age and the time frame from injury to presentation, I would be reluctant to suggest surgical repair. Was going to place him in an AFO initially to try and maintain foot position and help gait, but patient wanted to wait and see.
Suggestions?
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