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

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Presentation transcript:

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 Hot, erythema over lateral aspect DP/PT Pulse ++

Past Hx Gout L foot stress fracture 4 th 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

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

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

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.