Dear All,
I agree with Paul. If they are getting night pain then i would tend to go for MR
or Isotope bone scan. Plain films are not always sufficient to rule out
bone/joint pathology. I am not sure if US is going to give you much here. I
would tend to go for the isotope and see if there is increased uptake in the
midfoot. It may well be degenerative change but you need to be sure!
cheers
Andy
Andrew Williams
Department of Orthopaedics and Trauma
The Royal Liverpool University Hospital
Quoting Andrea and Danielle <[log in to unmask]>:
> Thank you all for your input regarding this topic.
>
> I thought I would let you all know how things are coming along. The
> Pedder's disease was actually Paget's disease and the results were negative.
> As mentioned in my initial posting, Xrays indicated nothing sinister,
> however I have taken Grahame's advice and referred for an ultrasound. She
> returned to my clinic the day after my posting for review. She stated that
> after swimming the previous day, the pain had been worse. This finding
> seemed to fit the diagnosis of DMICS as when kicking there is a
> plantarflexion force on the forefoot relative to the rearfoot. I performed
> the forefoot plantarflexion test and got a positive result for the 3rd and
> 4th rays. As I didn't have Kevin's advice I used some lateral thinking and
> decided to perform some mobilisation of the midfoot area to reduce these
> compression forces and sent her on her way.
>
> She returned 4 days ago with massive improvement. After mobilisation she
> was in agony for a day, however, she has now gone from waking up 7-8 times a
> night and having to actually get out of bed and walk to relieve the pain, to
> now waking once a night and only having to move the foot slightly to reduce
> the discomfort. I am still awaiting the u/sound results, but all seems like
> it is sorting itself out. Paul I examined her footwear and they are all
> wide lasted lace-up shoes. There is no evidence of tightness in the shoes.
>
> I will take your advice Kevin and get her onto those stretching exercises,
> and she is already icing.
>
> Thanks again for all of your input.
>
> Kind Regards
> Andrea
>
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