Have you considered pttd?
----- Original Message -----
From: "Ian Baxter-Wild" <[log in to unmask]>
To: "Grahame Mann. F.C.Pod.S." <[log in to unmask]>
Sent: Thursday, November 25, 2004 7:29 PM
Subject: Blateral foot pain
> This 21yrs lady was referred to my clinic in Aug 2004 c/o pain around the
> medial aspects of both ankles L>R. She gave a history of treatment for
> right-sided foot pain extending back to 1999. This has consisted of
> initial pain in R foot over base of 5th met. XR normal. 4/52 in a BK
> cast. Pain resolved. 3/12 later, pain returns. MRI scan - results; no
> bony abnormality, thickenining within posterior TF lig, ? soft tissue
> abnormality over lat malleolus.
>
> Then ref to physio for ultrasound and mobilisation. Physio provided her
> with orthoses to address a rearfoot overpronation they had identified. Pt
> then at univ with various amounts of foot discomfort. She attended a
> podiatrist in Feb 2003 c/o painful swelling overlying the right navicular
> bone medially, catching her footwear. X-ray showed enlarged medial
> portion of navicular, no accessory ossicles identified. Provided with
> orthoses to off load PTT.
>
> In July 2004 she had been relativly comfortable with the orthoses but she
> was still very tender over both navicular prominences R>L. She was
> compensating by walking on the lateral borders of her feet and developed
> ilio-tibial band syndrome. She was rested in BK casts for 4/52 and physio
> to follow with ankle exercises.
>
> When I saw her in Aug 04 the pain was extending from the lower 1/3 of the
> TAch along the medial border into the 1st MTP. +ve Tinel sign. Injection
> into tendon sheath failed to resolve the pain. Pt presently on crutches
> and NSAIDs. Pt is well physically, seeing gynacologist for heavy
> period/pain.
> Further MRI scan arranged, also to include lumbar spine due to ?irritable
> bladder. Also referred to Neurophysiologist for nerve conduction studies
> and Pain Relief clinic ?complex regional pain syndrome.
>
> Any further input would be welcome.
>
> Thanks.
> Ian
>
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