A male in his late 20’s stopped by the clinic with bilateral ankle pain. This patient inspects roofs for an insurance company and spends a great deal of time walking on sloped surfaces. His right ankle was initially treated because it very painful and debilitating. He was diagnosed with peroneal tendinitis and responded well to care very quickly.
He came to the office stating that his left ankle pain was really bothering him and he would like us to start physical therapy treatments. His ankle was quite swollen and tender on the outside of his foot.
Tuning forks (a two-pronged steel device used by musicians, which vibrates when struck to give a note of specific pitch) can be quite useful at identifying fractures and/or problems with the bone. The theory is that the vibration causes the two end of a fracture to vibrate and thus causing a severe pain response.
The patient jumped off the table when I put the tuning fork on the base of the outside of his foot. He was also quite tender with stretching his foot.
I explained to him that there is some evidence to suggest that he may have fractured his foot. I called his primary care physician and explained to him my results.
He had Xrays of his foot and it had shown no fracture. However, they did diagnose him with Gout, a metabolic disease in which crystals form in the joints. He was prescribed medications and his symptoms began to significantly improve.
- A complete physical therapy exam, in collaboration with other medical providers, lead to correct interventions for an atypical presentation of gout
- The tuning fork test resulted in a false positive for a fracture. I have never previously considered Gout as a condition that would cause pain in this way, but clinical findings did suggest that patient condition required additional follow up with the physician.
- Appropriate referral patterns and examination led to a speedy resolution of the problem and unnecessary physical therapy visits.