The patient presents today for first time evaluation of right foot pain. He states that approximately two months ago after buying a new pair of shoes, he began to have pain across the top of his right foot. He states that he has no pain at rest but that it hurts when walking or performing specific activities. The foot is functional but painful and he has not noted any swelling, erythema, or ecchymosis. He denies any sharp stabbing pain or radiation into the toes and presents today for evaluation.
New pain in dorsum of right foot; query mono-osteoarthropathy versus stress fracture versus ligamentous injury.
As this has been going on over two months and it is limiting his function, I feel that x-rays are appropriate at this time. We will obtain x-rays of the right foot and I will start him on a course of Voltaren gel. We will see if this helps over the next two weeks.
After we obtain the results of the x-rays, we can consider whether or not this pain/injury is rehabilitatable or if further imaging is warranted. We may actually be able to treat this pain with the use of injected glucocorticoid as well, but we will wait for the results from the plain films.
He is happy with this plan of care and he will follow up with me in next four weeks or sooner if needed with either of our physician’s assistant or Dr.