CHART NOTE
She has a painful left bunion and a painful arch of the left foot. This is causing the lateral toes to be impinged upon. She also has trouble fitting her shoes.
On examination, she has decent range of motion but a moderately severe hallux valgus to her left great toe and pronation at her midfoot. X-rays show a large deviation at the metatarsophalangeal joint of the great toe; otherwise, there are no specific signs of degenerative arthritis.
I think she could use at least an arch support and possibly operative correction of her first toe. She is going to think about both these options and get back to me in the near future.
CHART NOTE
He states that he still has some pain in the ankle, especially after long walks. It is a dull aching that occasionally seems to give out on him.
On examination, he seems to have a stable ankle with some tenderness in the anterolateral joint line. X-rays show perhaps a traumatic cyst in the dome of the talus. Because of this, I have suggested tomography and a bone scan. He is going to check on his insurance coverage and get back in touch with us.
CHART NOTE
She is still having pain in her right knee, and she cannot straighten it fully. There was no obvious instability; however, because of the persistent pain, a x-ray was taken. This was negative.
We are going to arrange for diagnostic arthroscopy sometime in the near future. If this is negative, at the same time we can inject the medial femoral condyle with some cortisone.
CHART NOTE
Is having some pain around the medial aspect of his left knee. About 12 years ago, he had a bucket-handle tear of his medial meniscus, which was removed. He has had some dull pain there for a couple of months. Sometimes it is sharp. In addition he has some tenderness around the base of the right great toenail, especially when he extends his toe up against the shoe. This has also been present for the last couple of months.
On examination, he has a well-healed medial scar to his left knee. There was no effusion, full range of motion, and it is stable.
X-rays show perhaps very slight squaring of the medial femoral condyle and a small chip or small accessory bone medially, but nothing in the interior of the joint. The right great toe shows a healed fracture. There was no obvious exostosis impinging on the base of the nail.
He is going to wear a pad on the base of the nail, and we will start some physical therapy for his knee, and I will see him again in approximately 2 months.
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