case 8

A 20 year old female patient presented to our OPD with 

complaints of pain in her left foot since about 10 months and 

swelling in her left foot since 3 months. 

HOPI 

Patient was apparently asymptomatic 10 months back when she developed pain in her foot which is insiduos in onset, of dull aching in nature, aggravated by standing and walking, and relieved by taking rest and/or medication. Pain is of increasing severity and is continuous  since last 2 months. 

Patient developed swelling in her left foot about 3 months back initially diffuse and gradually localized to mid dorsum of foot. There is no history of increase in the size of the swelling.

No h/o trauma

No h/o fever/ weight loss / constitutional symtoms.

No h/o numbness or paraesthesias in the foot.

Past History

No h/o similar complaints i the past.

No h/o TB/ DM/ HTN/ Asthma/ epilepsy/ bleeding disorders.

No h/o past hospitalisation/ surgery

Personal History

Diet mixed

Appetite normal

Sleep disturbed of late due to pain

Family History:

No h/o similar complaints in family members.

No h/o any tuberculous contact.

General examination

20 yr old female who is c/c/c, moderately built and nourished.with pallor,and is without icterus, cyanosis, clubbing,  generalized lymphadenopathy, and pedal edema.

Gait antalgic

Vitals stable

other systems normal

Local examination of her left foot

Inspection

A globular swelling of 3cms diameter is noted over the dorsum of her left mid foot.

swelling is diminishing in size on extension of toes and surface is smooth ,skin over the swelling is normal, no scars and sinuses no visible pulsations, and no local inflammatory signs noted. surroundings are normal.


Palpation:
Local warmth noted,
Deep tenderness noted over the cuneiform bones and the bases over first second third metatarsal.
Swelling site and size are confirmed,skin over the swelling is pinch able and the swelling is uniformly soft  in consistency fluctuant , margins well defined and has minimal mobility in AP and lateral directions. No translucency, neither reducible nor compressible.



Workup and radio graphs attached
MR will be attached shortly

9 months old x rays

Present X rays

Histopathology report of Open biopsy attached

Aspiration yielded straw colored thin fluid which was sterile on microscopy and culture
Open biopsy yielded bits of cheesy material and bony spicules of medial and middle cunieform bones.

What is your clinical radio logical and final diagnosis
how would you like to further manage this patient?