Run Over By A Water Buffalo: Perineural Prolotherapy For Refractory Pain - Page #1

Author: Benjamin Buchanan, MD
Senior Editor: Warren Bodine, DO, FAMSSM
Senior Editor: Margaret Gibson, MD, FAMSSM
Editor: Rathna Nuti, MD

Patient Presentation:
A previously healthy 33 year old female patient reports 5 months of severe left foot pain after a military water buffalo rolled over her left foot and ankle.

Aside from the initial injury, patient reports no previous injury or pain to the left foot. She reports diffuse pain, hypersensitivity, minor swelling, and temperature changes to dorsum of the foot since initial incident. Pain is 2/10 at rest but ambulation or any significant touch to the area causes pain to be 8/10. Pain is described as sharp and also like pins and needles. She notes that she has been able to tolerate more pressure gradually but this effect has plateaued. NSAIDs/Tylenol have not had any effect. She reports resting and avoiding significant exertion for over a month without any noticeable improvement. She also reports doing some physical therapy but unable to tolerate due to level of pain.

Physical Exam:
Foot exam (left):
Inspection: antalgic gait, no swelling, erythema, bruising, or atrophy
Palpation: Diffuse allodynia over dorsum of the foot
Strength/ROM: 5/5 muscle strength throughout and full ROM of ankle and all toes, movement painful
Neurovascular: full sensation and proprioception
Special Tests: unable to reliably perform due to level of sensitivity/pain

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NOTE: For more information, please contact the AMSSM, 4000 W. 114th Street, Suite 100, Leawood, KS 66211 (913) 327-1415.

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Phone: 913.327.1415

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