Hi Bruce,
From my experience the plain film is not always conclusive. I recently saw a
patient with pain over the talonavicular joint. This was put down to 'wear and
tear'. The AP, Lateral and oblique films looked 'normal' to me and the
radiologist. Further questioning and there was no obvious trauma and it had
started to be painful at night with the help of asprin! I then asked for a MR
and an osteoid osteoma confirmed. Although benign i referred to the orthopaedic
oncologist.
cheers
Andy
Andrew Williams
The Royal Liverpool University Hospital
Quoting Bruce Williams <[log in to unmask]>:
> 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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