I'd like to ask if anybody can shed light on this (perplexing) problem.

My right foot has been swelling up for the past 2 months, to varying degrees, affecting more or less of the foot/ankle.

No injury preceded the initial swelling.

The initial swelling was confined to the top of the ankle, creating a 'fluidy' soft swelling which extended from the top pf the foot where it joins the ankle - forwards for about 6cm. This episode passed and nothing happened for about 2 weeks, when the swelling came back and has been present ever since, once again to varying degrees.

Here's a list.

On a scale of 1 to 10, the pain/stiffness can be 9 first thing in the morning, then goes to scale 4 after a hot bath, then to 3 after walking a short distance. Pain goes back to 6 or 7 if I sit for a while.

The foot was unmovable in a twisting left to right motion. Eg. When driving and moving foot from accelerator to brake pedal - no longer possible - have to lift foot and 'stamp'.

Up and down flexing painful. OTC pain killers made no difference.

Went to my doctor who said it was tendontis.

One week later my doctor referred me to a rheumatologist (sp?).

The rheumatologist suspected Erythema nodosum or sarcoidosis.

I was given a cortisone injection (intra musclular) which worked quickly to alleviate the pain.

Blood tests showed:-

No Rheumatoid/arthiritis
Elevated 'values' suggesting an infection - but not anything 'serious serious serious'. ie. Yes, there's an infection you're fighting. (Which supported the EN diagnosis).
Chest x-rays showed all clear Re. Sacoidosis & lymph nodes.
Uric acid was minutely higher than 'normal' ie. Negligible. & therefore not gout.

Consultant said that the cortisone would take a few more days to do its work.

Consultant is now away on 3 weeks vacation and the top of my foot has swollen up again and become very puffy. When I knead the puffyness, it's as if a liquid is moving around under pressure.

Pain has gone back up to 7 or 8 at times.

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Other (possibly relevant info).

Have had a DVT in that leg 9 years ago.

Get lots of leg cramp in that leg.

Varicose veins.

Exercise now can make it better or worse.

It's slightly hot to the touch.

The swelling extends from the top middle of the foot forwards and across to the left towards the big toe in a puffy ridge.

The swelling is not red (which makes me wonder whether it really is/was EN).

X-ray of ankle showed 'all clear'.

Male aged 45, smoker (?)
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Naturally, I'll go back to the rheumatologist when he returns, but in the meantime, I wonder if anybody has any other ideas?

Got me stumped I would recomend seeing a vascular Doctor for a second opinion.

Get well

Possibly Extensor tendinitis?

But the symptoms only fit 50%

Dear Meercat
Since the venous system sustained prior trauma from the history of a DVT, the extremity may continue to remain swollen. Have you seen a vascular surgeon for an evaluation ?

Good-luck and thank-you for contacting foot.com
Sbarlizo, DPM, C Ped
foot.com expert

Hi Sbarlizo,

I saw my consultant again and he gave me another shot of cortisone saying that sometimes it takes a double dose to really knock the problem out. He reckoned that it is/was extensor tendinitis. Since this last injection, the pain really has subsided and the foot feels absolutely ok. Fingers crossed - that's sorted it out.

I did ask him about the possibility that the extremities may be affected by the previous DVT and he seemed to be pretty confident that that wasn't the cause. Nevertheless, it's tendinitis of a sort and from what I've gathered, the poorer your circulation, the harder it is for tendons to repair owing to reduced blood supply. Then again, neither of my feet are 'cooler' or blueish or having a different temperature - so maybe the circulation really is ok.

He also gave me the X-rays of my ankle/foot and it all looks very good. ie. with good cartilage/bone separation and even thickness. I was rather impressed with it......

Thanks for your ideaas Sbarlizo..... and I'll let you know if it flares up again - but at the moment it looks like the 'second fix' fixed it.

P

Dear Meercat
Good to hear that you are doing better! One last note, smoking has serious affects on circulation and healing, so, if you are a smoker, try to stop.

Good-luck and thank-you for contacting foot.com,
SBarlizo, DPM, C Ped
foot.com expert