51 year old male with foot drop

September 22th ,2022

This is online E-blog, to discuss our patient de-identified health data shared after taking her guardian's signed informed consent.

Here we discuss our individual patient problems through series of inputs from available global online community of experts with an aim to solve the patients clinical problem with current best evidence based input.

This E-blog also reflects my patient's centred online learning portfolio.

I have been given this case to solve in an attempt to understand the topic of "Patient Clinical Data Analysis" to develop my competency in reading and comprehending clinical data including history, clinical findings, investigations and come up with a diagnosis and treatment plan.

51yr old male patient came with chief complaints of

C/o Swelling in the left foot since past 3years

C/o Progressive loss of sensation in the left foot since 3years

C/o Ulcer in plantar aspect of left foot from past 11months

HOPI:

The patient was apparently asymptomatic 25 years ago later when he was playing football then accidentally his left foot went into a ditch which lead to diffuse swelling in his left foot up to the ankle joint. This Swelling lasted for 1week,it was not a/w fever,change of colour of overlying skin or loss of body weight.

The pain was a/w Swelling which was localised to the left foot below the level of the ankle joint. Patient was unable to walk, and thus visited a doctor and he prescribed medication for a week, after which the Swelling and pain resolved.

3years ago, while going for morning walk, patient accidentally placed the same foot into a ditch and it got twisted. Immediately after, patient experienced swelling in the left foot, predominantly in the lateral aspect of the dorsum of the foot.

Swelling was a/w pain and not a/w change in body weight,fever or change in colour of the overlying skin.

The patient visited a doctor and an X-ray of the left foot was done, which depicted a crack on the lateral aspect of the plantar of the foot. Patient was advised to undergo surgery,but he didn't and continued medication which was prescribed for the next nine months. And patient could walk with a limp. The Swelling didn't completely subside.

A week after patient experienced tingling sensation in the little toe which progressed medially towards the great toe and patient was unable to flex the great toe towards the dorsum. Later patient could not flex the foot toward the dorsum. He also complaints of that while wearing his slippers,those slippers keep coming off his feet.

11months ago, the patient developed an ulcer in lateral aspect of the plantar of left foot. Patient did not initially notice the ulcer as there was loss of sensation present at the time. When patient first noticed ulcer, it was given cadexomer iodine ointment which did not provide any relief,later in addition to ointment, patient was given oral medications,which have been effective in reducing the size of ulcer. And ulcer is still present.

Past history:

Not a k/c/o DM, HTN, TB, CAD, ASTHMA, EPILEPSY.

Personal history:

Diet: mixed

Appetite: normal

Sleep: adequate

Bowels: regular

Micturition: Normal

Addictions:Chronic smoker for the past 15years

Family history:

Not significant

General examination: