Author: Priya Sharma, DO
Co Author #1: Sarah Merrill, MD
Senior Editor: Joseph Chorley, MD
Editor: Natalie Stork, MD
Patient Presentation:
Thirty year old female presented with 1 week of right foot pain.
History:
Thirty year old female with history of low bone mass and multiple stress fractures (femur and foot) presented with 1 week of right foot pain. She reported 1 week prior she had walked "for miles" in poorly supportive sandals. She did have swelling of the foot the day after her long walk, which has resolved at time of presentation. Her pain was located over the dorsal aspect of the forefoot. Pain was worse with weight-bearing and at night. Pain was improved with rest. She stated this pain feels similar to prior stress fracture pain. The patient reported a 30lb weight gain over the past 5 months. She was not taking any medications.
Physical Exam:
Vital signs were within normal limits. On inspection of the right foot, there was no swelling, ecchymosis, or signs of trauma. She had tenderness to palpation of the 2nd, third, and 4th metatarsals. She demonstrated full range of motion with 5/5 strength. She had normal sensation of her right lower extremity with normal deep peroneal and posterior tibialis pulses. She had a positive metatarsal squeeze and pain with axial loading of her metatarsals. There was no instability of the MTP joint. Her left foot was normal by comparison.
Click here to continue. Challenge yourself by writing down a broad differential diagnosis before moving to the next slide.