Module 16, General Orthopaedist 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
is most likely a stress fracture followed by avascular necrosis of the
metatarsal head.
Question 16B
This
is Kohler's disease and does not have a traumatic origin.
Question 16C
Acetaminophen
should be sufficient and is recommended to control discomfort.
Question 16D
A
firm orthotic with a metatarsal bar would be adequate immobilization for
this patient at this time.
Question 16E
You
inform the family that this will probably require surgical treatment at
some time.
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