To all;
    Re: nite pain.  Often an Enchondroma can cause nite pain.  Often this is
alleved by salicylates, and sometimes by ibuprofen.  If this was mentioned
previously, I apologize.  Obviously, there will be a cyst visible on x-ray
in this condition.
    Further on this, I had a patient last week who presented w/ 20 years of
ankle joint nite pain, to the extent she had to take aspirin at nite to
sleep, and then still constantly had to move her legs and feet around a lot
to get comfortable.
    I saw no inflammation, and no one before had ever seen a positive x-ray,
though it had been 5 years since she last saw anyone.  She had a failed bout
w/ orthotics and tapeing and injections.
    I ordered an x-ray, but did not see it on initial visit.  I did find
quite a bit of AJ equinus, FnHL, and hypermoblity of the MTJ and 1st ray.  I
subsequently put her into a modified low dye w/ no heel lift.  She wore the
tape for two days and this was the first time in 20 years she was pain free
at night 2 times in a row!  The tape then came off and the pain returned.
Her x-rays are negative.  We casted her for orthotics today!
Just an interesting story.
Sincerely;
Bruce
----- Original Message -----
From: "Andrew Williams" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 25, 2004 2:30 PM
Subject: Re: Dorsal Foot Pain


> 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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