Hi Everyone
I have currently attending my clinic, a 54 year old female complaining of
dorsal foot pain of a 4 week duration. The pain only manifests itself in her
left foot and only when non-weightbearing. It is especially painful at
night. The pain begins as a dull ache and if nothing is done, progresses to
a very sharp pain. The client states that by getting out of bed and walking
around the pain subsides. It is tender at the beginning of gait, but then
settles enough to allow her to return to sleep. When asked if any trauma had
occurred to the left foot the answer was no, and she had not been on
holidays or done any long distance driving. Her local doctor referred her
for X-rays (which show nothing sinister) and performed a blood test for
"Pedders Disease" (these are the clients words), which also came back
negative.
Initially she presented to one of my associates who performed a
neurovascular assessment. The thought process was that the pain may have
been caused by vascular insufficiency. The results were good, and although
the Doppler result indicated some negative changes, they were nothing to
write home about, and not in my opinion, enough to cause this type of pain.
During my examination I noted some tenderness on the palpation of the medial
STJ and, under active resistance, on the palpation of Tib Ant and extensors.
There was no pain on palpation of the midfoot area. ROM testing of both feet
indicated no significant difference from right to left, with good strength
in all muscles. In gait she exhibited STJ and midfoot collapse (again no
difference left to right) with significant forefoot abduction. She was
apropulsive and had the associated abductory twist and medial roll off. No
significant instability was noted in either foot.
To be perfectly frank, I'm at a bit of a loss. I have applied some Opsite
wrapping to rule out early signs of peripheral neuropathy, but this is
purely a diagnostic test and not something I feel will make significant
improvement. Can anybody help me??!!
Kind Regards
Andrea Castello

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