I am deeply happy to report that I am wrong about the IT's knee.
Knee MRI was normal and I got to watch orthopod Dr. E examine her. The IT gave a very clear and concise history. He said the knee is fine and said it's a synovial pinch. The synovial fluid is the fluid in the knee that pads it. The synovium is the sack around the synovial fluid that holds the synovial fluid. When it pooches out in back of the knee, that is a Baker's cyst. She tore her medial collateral ligament two years ago twisting with the leg planted in a sailboat (racer in college) and ended up in the ER. It was locked. He said the pains move around because the synovium is caught in different places.
Done.
But wait, I say. What about the foot? She says she can't fully flex her left foot. And this knee thing started with a pain in the left foot in the arch. Weird.
Off comes her shoe and he does a foot exam. He is enjoying the audience, both me and a new physician's assistant, young, cute and female. Plus my daughter and a nurse.
Ah, he says, here is the problem. A talocalcaneous bridge, I think. Do you know what that is?
Nope, I don't and neither does the PA. The IT is the last patient of the day so he decides to use the floroscope instead of sending her for an xray. We are looking for a beak shaped bone protrusion from the talus pointing towards the calcaneous. And there it is. A beak.
What about the other foot? says the IT
The bone is half as long, not beaked.
You will need a foot MRI, says orthopod. Stretch the knee, hot baths and set up with PT to learn to walk right again. The bridge is usually cartilage diagnosed age 13-15 in runners and in older folks it can be bone.
We don't ask the treatment. The nurse also adjusts the crutches and shows the IT how to use them correctly. The Urgent Care had basically adjusted the height, but not the handles, so they were set too long. Urgent Care people had not said a word about how to use them. And I almost never put people on crutches because my patients were average age 70-something. If they were broken, I sent to ER or ortho, depending.
I ask the IT about running on the way home. "I only ran once a month until last year. Then I started running a lot. I noticed that foot worked differently than the other but I just worked around it." So: covid. Pool was closed, sailing shut down, climbing wall shut down. She did running as the exercise of last resort.
My book says cast or surgery, but my book is OLD. So maybe they have something new and cool to fix it. The IT hopes they can inject something to melt the cartilage. Well, but... there is a lot of cartilage in the foot that one needs to keep intact.
Hoorah, hoorah, I am so delighted to be wrong and that it is NOT her ACL.
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