Severe Bilateral Ankle and Feet Pain in 27 Years Old Lady
27 Years Old Syrian Lady, In Good Socioeconomic Level, Without Remarkable Past History and Trauma, In Breast Feeding Period, on Different Kinds of NSAIDs (Non-steroidal anti-inflammatory agents) With Relative Response To Ibuprofen 800 Mg. She Has Had Severe Bilateral Ankle and Feet Pain For 2 Months, Since The Last Month of Pregnancy and The Pain Has Been Increasing After Normal Delivery 20 Days Back, She Was on Wheel Chair and Couldn’t Walk Without Assistance According To The Pain and Referred By A Neurologist. Positive Findings on The Physical Exam: Severe Pain and Tenderness (Allodynia) on The Feet and Ankles, Soft Tissue Swelling without Redness, Warmness and Pitting, The Joints and Distal Pulses are Intact. Neurologic Examination Are Norma Although Tendon Reflexes and Sensory neural Level are Not Reliable Due To the Extreme Tenderness.
Para-clinic Evaluations: Acute Phase Reactants, Serologic Markers, Metabolic Bone Markers All Are Normal.
The First Feet X-ray Reveals Sever Diffuse Osteoporosis.
Comparative X-ray after 2 Weeks: Progressive Demineralization in Patchy Pattern.
Feet MRI: Increased Signal in Tarsal Bones Particularly Talus.
DEXA Scan: Osteoporosis in Spine, Forearm and Hip.
Tuesday, January 30, 2018 - 08:00