History: An active 78-year-old male, with a background as a recreational athlete, presented with acute onset of left foot pain, following an event of mechanical stress characterized by a popping sensation. His extensive medical history included interventions for systemic and musculoskeletal disorders, notably a carotid artery dissection and hip arthroplasty. Lifestyle factors included past smoking and minimal alcohol use. He reported a recent corticosteroid intervention of his left mid-foot for chronic discomfort.

Physical Examination: Orthopedic assessment revealed moderate left anteromedial ankle swelling and ecchymosis with palpable tenderness. A comprehensive evaluation of his lower extremity mechanics showed preserved strength across all tested muscle groups and a full range of motion, negating any neuromuscular impairment. Normal left leg sensation and a warm and well-perfused extremity were presented, eliminating potential neurological or vascular complications. No foot drop was noted. Biomechanical analysis indicated abnormal gait patterns underpinned by equinus and pes planus deformities.

Differential Diagnosis:

  1. Acute Anterior Tibialis Tendinopathy
  2. Progressive Midfoot Osteoarthritis
  3. Functional Limb Length Discrepancy
  4. Radiculopathy of L4 Nerve Root

Tests and Results: Diagnostic imaging, encompassing weight-bearing radiographs and CT scans, delineated severe degenerative changes in the tarsometatarsal joints, with notable joint space narrowing and osteophytic proliferation. Additional findings included significant plantar calcaneal spur formation.

Final/Working Diagnosis: Acute tear of the left anterior tibialis tendon and advanced tarsometatarsal osteoarthritis, complicated by a pre-existing limb length discrepancy.

Treatment and Outcomes: The treatment strategy emphasized biomechanical correction and pain management. This included the implementation of a custom-fit ankle brace to stabilize the joint and mitigate load-bearing stress, supplemented by a structured RICE protocol. Further orthopedic follow-up was planned to monitor the conservative management's efficacy and evaluate the need for potential surgical intervention.



To view the content in your browser, please download Adobe Reader or, alternately,
you may Download the file to your hard drive.

NOTE: The latest versions of Adobe Reader do not support viewing PDF files within Firefox on Mac OS and if you are using a modern (Intel) Mac, there is no official plugin for viewing PDF files within the browser window.