From question posted here.
Well, as I said in the previous post, all the information you need was already given. Several of you came to the right answer, which was gout, but only one (studentdoctorgirl) explained why.
In med school you learn about “classic presentations” of certain diseases. The thing is that these days hardly anyone presents with the classic complaints. But this lady did. She apparently read the textbook description of gout, which states that many gout sufferers complain that their foot/toe/ankle is so painful that it hurts for even the bed sheet to touch it. I asked her if she always slept with one foot out from the covers, and she responded, “no, just since my foot started hurting. I can’t stand for anything to touch it.”
Of course you do have to rule out clots, arterial disease, neuropathy (which would be a close second but is usually bilateral), and occult fracture as well, but given the patient’s lack of warmth, erythema, swelling, or tingling, and her excellent pulses and sensation in her feet, AND normal X rays, those sort of all fall to the wayside. But hey, if I had given you ALL the details of the physical exam, it would have been too easy, right?