Hallux rigid

This 35-year-old pleasant female presents today for an initial evaluation acute onset of right great toe pain which she started experiencing shortly after she started power walking three and half miles over the past four weeks. The patient states that over the past two weeks her symptomatology has worsened despite wearing tennis shoes with insoles when walking. The patient states that she has had pain in her right foot in the past approximately two years ago and she saw a podiatrist. X-rays were performed. Results were negative. The patient was given custom fitted orthotics. The patient states that her pain symptomatology decreased and now her pain is very localized to the right great toe. The patient went to go see her primary care physician Dr. for treatment recommendations. Dr. has referred the patient for physical medicine and rehabilitation, gave the patient a prescription for ibuprofen 800 mg, and recommended massage and heat to the area. The patient presents today stating that her symptomatology has worsened over the past few days. She describes her pain as a constant, throbbing, sharp pain with stiffness of the joints primarily and very localized to the great right toe.

ASSESSMENT:
1. Hallux rigid.
2. Turf toe.
3. Sprain/strain, metatarsophalangeal joints.
4. Chronic right great toe pain.

Plan:
1. Recommend passive modalities of ultrasound to the great toe.
2. Include active rehabilitation and therapeutic exercises and activities.
3. X-rays of the great toe to be performed in an effort to rule out possible several fracture, rule out progressive arthritis and loss of joint space.
4. Follow up in one week for review of x-ray findings and make further recommendations.

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