A 68-Year-Old Man Comes to the Office with a 2-Day

A 68-year-old man comes to the office with a 2-day history of right foot pain and swelling.  The pain started acutely when he awoke in the morning.  Initially, the patient had pain only on dorsiflexion of the foot, but he progressively developed pain with any movement at the ankle or weight bearing.  The patient has not had similar symptoms before.  He is normally very active, and had spent a week bicycling in Utah 3 weeks prior to this presentation.  Medical history is notable for type 2 diabetes mellitus, hypertension, and hyperlipidemia.  Temperature is 37 C (98.6 F) , blood pressure is 140/90 mm Hg, and pulse is 90/min.  Examination of the right foot shows warmth, swelling, and tenderness over the dorsal surface of the foot and around the right ankle.  Both dorsiflexion and plantar flexion are restricted due to pain.  The skin is intact without ulcers or breaks.  Pulses are full and equal in both feet, and sensory sensations are normal.  X-rays reveal soft tissue swelling, small tibiotalar joint effusion, and chronic calcification of the articular cartilage.  There are no fractures or dislocation.  Which of the following is the most likely diagnosis?

A) Bacterial infection of the ankle joint
B) Calcium pyrophosphate arthritis
C) Monosodium urate arthritis
D) Neuropathic joint
E) Plantar fasciitis
F) Stress fracture

Correct Answer:

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