56 years old man walking his two dogs in the morning, was suddenly taken off guard when the dogs got excited after spotting a herd of pigs and pulled free from the leash toppling the man in the process. As soon as he fell he suffered from excruciating pain in left knee and base of left great toe and barely managed to walk home limping with pain.
On examining of the knee and toe in the evening:
Radiology of the foot:
Day 2 morning:
Day 2 evening:
Objective examination and interpretation: Swelling persists due to traumatic inflammation.
Confirmed on palpation with no palpable fracture dislocation
Subjectively as related by the patient and interpreted by physician:
The pain exacerbates on prolonged sitting and produces marked stiffness in surrounding muscles which reduces slowly on prolonged walking suggestive of ligamental inflammation or enthesitis
Day 4 update:
Left Metatarsophalangeal joint looks even more spell and pain appears more than day 1!
The swelling and pain of left knee is persistent. Patient hasn't taken any analgesics till now
Day 7 evening update:
Subjective: The swelling and pain of left knee is persistent only in a different flavour as the morning pain immediately after waking up and after initial mobilization is slightly less but every time the patient sits for sometime and then attempts to get up and walk the pain and stiffness keeps recurring. Patient hasn't taken any analgesics till now
The left MTP swelling is not reducing and pains often during walking with shoes when it gets compressed antero posteriorly by the shoes. The patient recalls having much milder version of similar pain and swelling of the left MTP induced by footwear since last few years. The incidental findings in the foot x-ray appears to point toward a prior gout.
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