What is the appropriate management for a 33-year-old male with bilateral foot pain and left shoulder pain due to an acromioclavicular joint injury?

From the Guidelines

I strongly recommend providing the 33-year-old male patient with McKesson insoles, size 10.5, with metatarsal support for his bilateral foot pain, and referring him to physical therapy for his left shoulder AC joint pain. The patient has been experiencing bilateral foot pain since 2021 and has been self-managing with naproxen and ibuprofen. The custom insoles with metatarsal support will help redistribute pressure across the foot, potentially reducing pain by providing proper arch support and cushioning, as recommended by the EULAR guidelines for the non-pharmacological core management of hip and knee osteoarthritis, which suggests the use of appropriate and comfortable shoes 1. For his left shoulder pain, which began after an injury in October and is described as sharp and deep in the clavicle area, physical therapy is appropriate to improve range of motion, strengthen supporting muscles, and reduce inflammation around the AC joint. The patient has agreed to this plan of care. While continuing with his current pain management using NSAIDs (naproxen and ibuprofen), he should be advised about potential gastrointestinal side effects from prolonged use and the importance of taking these medications with food. Additionally, the treatment of glenohumeral osteoarthritis, as discussed in the clinical practice guideline by the American Academy of Orthopaedic Surgeons, highlights the importance of considering various treatment options, including physical therapy and pharmacotherapy 1. However, the most recent and highest quality study, the EULAR recommendations, takes precedence in guiding the management of this patient's condition 1. Key aspects of the patient's care include:

• Providing custom insoles with metatarsal support to alleviate bilateral foot pain
• Referring the patient to physical therapy to address left shoulder AC joint pain
• Continuing current pain management with NSAIDs while monitoring for potential side effects
• Educating the patient on the importance of proper footwear and potential benefits of physical therapy in managing osteoarthritis-related pain.

From the FDA Drug Label

After observing the response to initial therapy with naproxen tablets, the dose and frequency should be adjusted to suit an individual patient's needs. The patient has been using naproxen and ibuprofen for bilateral foot pain and left shoulder pain.

• The dose and frequency of naproxen should be adjusted to suit the patient's needs.
• The patient's current dose is not specified, but the recommended dose for pain management is 500 mg, followed by 500 mg every 12 hours or 250 mg every 6 to 8 hours as required.
• The total daily dose should not exceed 1000 mg of naproxen. Since the patient's current dose and response to therapy are not specified, it is recommended to monitor the patient's response to the current therapy and adjust the dose as needed 2.

From the Research

Patient Complaints and Treatment

• The patient is a 33-year-old male with complaints of bilateral foot pain and left shoulder pain.
• The patient has been using naproxen and ibuprofen to manage the pain.
• The patient is requesting McKesson insoles with metatarsal support, which he has previously used.
• The patient also reports left shoulder pain, attributed to the AC joint, which he describes as sharp and deep in the clavicle.
• The patient injured his shoulder in October of the previous year.

Diagnostic Imaging and Physical Therapy

• The patient will be prescribed physical therapy (PT) for his condition 3.
• Diagnostic imaging, such as magnetic resonance imaging (MRI), can be useful in musculoskeletal practice, but its use should be guided by clinical practice guidelines and evidence-based principles 4.
• The choice of diagnostic imaging modality depends on the suspected injured tissue and the patient's symptoms 5.
• MRI can be used to evaluate hip pain, but its findings should be correlated with clinical symptoms and physical examination results 6.
• Physical examination and imaging findings may not always be reliable in diagnosing musculoskeletal conditions, such as iliopsoas tendinitis 7.

Treatment Plan

• The patient has agreed to the plan of care, which includes PT and the use of McKesson insoles.
• The patient's response to treatment will be monitored, and adjustments will be made as necessary.
• The use of diagnostic imaging, such as MRI, may be considered in the future if the patient's symptoms persist or worsen 3, 4.