Module 16, General Medical Level

A 15 year and 4 month old female presented to the office with a complaint of left foot pain near the fourth toe for one year. She had no antecedent trauma. She described her pain as a constant, dull ache which had been getting progressively worse. She complained of exquisite tenderness with flexion and extension of her left fourth toe. She was tender to palpation over the dorsum of the fourth metatarsal phalangeal joint. She was unable to toe walk without inverting her foot to relieve pressure from the fourth metatarsal head.

Question 16A

This history is consistent with a foreign body such as a needle or wood splinter in the foot.

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Question 16B

On further questioning she states that several months ago the area was very red for a week or more. This makes you more concerned about the possibility of an infection.

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Question 16C

A careful history on the pain pattern, especially the presence or absence of night pain which awakens her from sleep is important in establishing a differential diagnosis.

Question 16D

The first test to be obtained in the work up of this problem is a CBC and ESR.

Question 16E

Because of the history and examination you would place her on crutches and make her completely non-weight bearing until the work up is complete.

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