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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