Chief Complaint: “Doc, my foot feels stuck!”
History of Present Illness (HPI): 52 y/o male with h/o fibromyalgia and chronic fatigue presents to Podiatry Clinic stating that his left foot has not been functioning normally for about six months, getting worse over the last several weeks. He reports no pain or tenderness. No fever or chills. No major trauma. He does recall walking on the boardwalk in Ocean City, MD last summer while barefoot when he stepped on a piece of ABC Gum (he clarified that this means “already been chewed”). He thought that he had removed all the gum using a small stick and then went about his business. Several months later he began to experience mild cramping of the medial left foot in the metatarsal region and this has progressed, altering his gait and causing mental distress.
Past Medical History: Borderline hypertension, GERD, hepatic steatosis, shingles (2016)
Past Surgical History: Appendectomy (1995), hemorrhoidectomy (2003)
Medications: Omeprazole, CBD oil, Xanax
Allergies: Penicillin, Marriage/Commitment
Social History: Occasional smoker, 10-12 drinks per week (the doubling rule applies here), sporadic marijuana use, works in finance
Physical Exam: Nontender left foot without swelling, ulceration, warmth, redness, or drainage.
X-ray Findings: Bridging bony excrescence joining the mid-shaft of the left first and second metatarsals. No acute fracture or erosion. Normal bone density. Mild DJD of the first MTP joint.
Assessment: Penetrating gum injury to the plantar surface of the medial left foot with proximal migration and secondary ossification resulting in ankylosis of the first and second metatarsals.
Plan: Regional block with open osteotomy and de-gumming in two weeks. The patient was advised to always wear shoes when walking outdoors and to never-ever-ever remove stuck gum from the skin surface with a stick or other sharp object. The patient appears to understand and agrees with the proposed course of action.
Time: I attest to spending approximately 15 minutes with the patient.
Great Exudations 