Splitting At The Seam

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Splitting At The Seam - Page #1

Author: Jonathan Bonnet, MD Co Author #1: Jonathan P. Bonnet Co Author #2: Thomas J. Cummings Co Author #3: Jeffrey Bytomski Patient Presentation: A 48 year old male recreational runner presents to clinic for evaluation of 10 days of left proximal dorsal midfoot pain and swelling. He had no known mechanism of injury or inciting event. His pain is intermittent and worse with dorsiflexion and ambulation. It does not awaken him from sleep. He has had mild persistent swelling along dorsal midfoot. He has had no changes to his training program or shoes, and is continuing his usual trail running of 50 miles per week. There are no alleviating factors, and his right foot is without pain. Review of Systems: No weakness, numbness, tingling, or foot drop. History: Past Medical History significant for: Left 2nd Metatarsal Neck Fracture (2004) Left 5th Distal Phalanx Fracture (2010) Left Non-Displaced Inferior Patella Fracture with Anterior Tibial Contusion (2010) No Past Surgical History. Physical Exam: Vital Signs: Stable. General: Patient is awake, alert and oriented, in no acute distress. Neurovascular: Sensation grossly intact, deep tendon reflexes 2+, normal gait. Dorsalis pedis pulses are 2+ bilaterally. Musculoskeletal: Left Ankle/Foot: Trace amount of swelling on the dorsal mid foot. Tenderness to palpation over the navicular. Full range of motion. 5/5 strength testing. Mild pain with resisted dorsiflexion. - Anterior Drawer: negative - Talar Tilt: negative - Squeeze Test: negative Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.		Back
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