Case Presentation:
Sinus Tarsitis following Inversion Injury
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Ryan Fitzgerald, DPM
PRESENT RI Associate Editor
Hess Orthopedics &
Sports Medicine
Harrisonburg, Virginia
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HPI: The patient is a 36 year old female who presents complaining of persistent pain along the anterior lateral aspect of her right ankle and foot, which is worse with weight bearing and ambulation and resolves somewhat with rest and ice. She relates that she has had a persistent pain for the last six to eight weeks, and states that for a time she thought her pain symptoms were improving. However, she now believes she has plateaued and is starting to have increase symptoms. While she relates no specific history of trauma, the patient relates to a previous history of numerous ankle strains. She relates to taking OTC anti-inflammatory mediations that only partially relieve her symptoms, and denies any other treatments.
PMH: gestational diabetes
Sx HX: C-section x 2, appendectomy
FMH: Mother has breast cancer, currently in remission, following radical mastectomy.
Medications: Birth Control pills, multi-vitamins.
Social History: The patient denies current tobacco usage, but states that she previously smoked and quit in 2003. She relates to social alcohol consumption and denies drug use.
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Physical Exam: Upon evaluation of the right foot, the patient demonstrates palpable pedal pulses which are graded +2/4 at the dorsalis pedis and posterior tibial arteries. Protection sensation is grossly intact via 5.07 semmes-weinstein monofilament; proprioception and vibratory sensation are both intact. The patient demonstrates palpable tenderness along the sinus tarsi and with passive subtalar joint range of motion. She grades this pain as 5/10. Ankle range of motion is intact and pain free without crepitation, and there is some general instability noted with rotatory motion. Despite this, she demonstrates a negative drawer sign. There is no equinus deformities noted. Muscle strength is assessed and graded +5/5 in dorsiflexion, plantarflexion, inversion or eversion. There are no skin lesions or ID macerations. Nails 1-10 are intact.
Imaging Studies: X-ray’s obtained of the right foot and ankle, three views each, demonstrates no fractures, dislocations, or periosteal reactions. There is a slight increase in talar declination. However, there is no medial arch collapse and there is congruency of the cyma line.
Considering the clinical exam presented, and the physical and imaging findings, how would you proceed in the management of this patient? Follow this link or click on the image below, to participate in the eTalk thread on this topic. The Conclusion of this case will be posted in an upcoming Residency Insight.
Keep writing in with your thoughts and comments. Better yet, post them in our eTalk forum.
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