Author: Amity Tung, MD
Co Author #1: Kenneth Taylor, MD
Editor: Marc Hilgers, MD, PhD, FAMSSM
Senior Editor: Marc Hilgers, MD, PhD, FAMSSM
65 year old male triathlete presents with right foot pain and swelling after running 16 miles while training for the Ironman. Location of pain is over the lateral dorsum of his right foot near the metatarsal heads, though he also reports some tenderness at the plantar arch. Pain is moderate, dull, worse with walking and moving, and improved with rest. He denies numbness, weakness, and tingling.
He reports having worn orthotics for years for flat feet. Of note, he recently was involved in a bicycle vs RV accident where he fractured his left clavicle and left fifth metacarpal. He also has a remote history of Grice procedure for his right foot at 10 years old, and superficial venous thrombosis in his left greater saphenous vein 5 years ago. Of note, he is adopted.
Right foot -
INSPECTION: Dorsal foot edema overlying second to fifth metatarsal heads. Varicose veins present in bilateral lower legs.
PALPATION: Tenderness to palpation along dorsal aspect of 2nd-5th metatarsal heads, as well as plantar surface of foot (arch and center of foot).
RANGE OF MOTION: Full dorsiflexion and plantar flexion. Severely limited inversion and eversion
STRENGTH TESTING: 5/5 resisted plantar and dorsiflexion.
NEUROVASCULAR: 2+ DP/PT pulses.
SPECIAL TESTS: Negative calf squeeze. Achilles tendon intact. Negative anterior drawer. Toe out gait with inflexible pes planus
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