Thanks Andy;
I'll keep that in mind if her pain returns.
Sincerely;
'Bruce Williams
----- Original Message -----
From: "Andrew Williams" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Monday, October 25, 2004 4:12 PM
Subject: Re: Dorsal Foot Pain
> 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
> > > >
> > > > -----------------------------------------------------------------
> > > > This message was distributed by the Podiatry JISCmail list server
> > > >
> > > > All opinions and assertions contained in this message are those of
> > > > the original author. The listowner(s) and the JISCmail service take
> > > > no responsibility for the content.
> > > >
> > > > to leave the Podiatry email list send a message containing the text
> > > > leave podiatry
> > > > to [log in to unmask]
> > > >
> > > > Please visit http://www.jiscmail.ac.uk for any further information
> > > > -----------------------------------------------------------------
> > > >
> > >
> > > -----------------------------------------------------------------
> > > This message was distributed by the Podiatry JISCmail list server
> > >
> > > All opinions and assertions contained in this message are those of
> > > the original author. The listowner(s) and the JISCmail service take
> > > no responsibility for the content.
> > >
> > > to leave the Podiatry email list send a message containing the text
> > > leave podiatry
> > > to [log in to unmask]
> > >
> > > Please visit http://www.jiscmail.ac.uk for any further information
> > > -----------------------------------------------------------------
> > >
> >
> > -----------------------------------------------------------------
> > This message was distributed by the Podiatry JISCmail list server
> >
> > All opinions and assertions contained in this message are those of
> > the original author. The listowner(s) and the JISCmail service take
> > no responsibility for the content.
> >
> > to leave the Podiatry email list send a message containing the text
> > leave podiatry
> > to [log in to unmask]
> >
> > Please visit http://www.jiscmail.ac.uk for any further information
> > -----------------------------------------------------------------
> >
>
> -----------------------------------------------------------------
> This message was distributed by the Podiatry JISCmail list server
>
> All opinions and assertions contained in this message are those of
> the original author. The listowner(s) and the JISCmail service take
> no responsibility for the content.
>
> to leave the Podiatry email list send a message containing the text
> leave podiatry
> to [log in to unmask]
>
> Please visit http://www.jiscmail.ac.uk for any further information
> -----------------------------------------------------------------
>
-----------------------------------------------------------------
This message was distributed by the Podiatry JISCmail list server
All opinions and assertions contained in this message are those of
the original author. The listowner(s) and the JISCmail service take
no responsibility for the content.
to leave the Podiatry email list send a message containing the text
leave podiatry
to [log in to unmask]
Please visit http://www.jiscmail.ac.uk for any further information
-----------------------------------------------------------------
|