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Case Presentation

Case Presentation. Presentation. 58 yo male ED 11/07 Generalised pain R foot – sole, lateral ankle and dorsum Worse at night Afebrile. Clinical Examination. Vitals Normal Painful ++ Right foot Tender Swelling over lateral ankle malleolus, all MTP’s,sole

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Case Presentation

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  1. Case Presentation

  2. Presentation • 58 yo male • ED 11/07 • Generalised pain R foot – sole, lateral ankle and dorsum • Worse at night • Afebrile

  3. Clinical Examination • Vitals Normal • Painful ++ Right foot • Tender • Swelling over lateral ankle malleolus, all MTP’s,sole • Hot, erythema over lateral aspect • DP/PT Pulse ++

  4. Past Hx • Gout • L foot stress fracture 4th metatarsal – • Cam boot & crutches • Pt been weightbearing on right foot for 1/12 • IHD – stents X5 2005, HTN • Cholesterol • L shoulder replacement and bone graft • L knee arthroscopy X3 ALLERGIES - Iodine

  5. Medications • Pantoprazole 40mg Daily • Diazepam 5mg PRN • Fenofibrate 145mg Nocte • Aspirin 100mg Daily • Candesartan/HCT 16/12.5mg Daily • Allopurinol 100mg Daily • Atenolol 50mg Daily • Colchicine 500mcg Daily Past 1/12: • Panadeine forte • Valium PRN for muscle relextant • Voltaren PRN

  6. Investigations • UEC- normal • FBE: Normal • Neutrophil: Normal • CRP: 37.6 • Xray for foot

  7. Treatment Plan • Colchicine 1mg tds • Continue allopurinol • NSAIDs for 3/7 • Gout flare? Septic arthritis? • Given generalised nature of swelling and pain with no specific joint involved, unlikely septic arthritis • No WCC/CRP rise • Elevate and ice foot and see if any improvement.

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