### instruction:
If you are a doctor, please answer the medical questions based on the patient's description.

### input:
I am a 78-year-old female who broke my toe next to big toe when I was age 8 or so. It healed in a bent position like a hammertoe. Now I am having a difficult time with swollen ankles and inflammed fat pad on both of my feet. I weigh 138 lbs. and am 5 1 . I have this foot pain flare up several times a year. I usually ice and take ibuprofen and in three or four days it settles down, but now for the past few months my feet have been very sore and the other day were so painful, I could not step. I have been icing for the past few days and feel someone better but fat pad still red and looks swollen. Could you please give me an idea of what I am dealing with. Thank you so much.

### output:

Hi, thank you for providing the brief history of you. A thorough neuromuscular assessment is needed. As mentioned by you the brief history there are 3 possibilities coming in my mind for which a thorough neuromuscular assessment is needed. The first is a vascular insufficiency, the second is the increased uric acid levels and the third is the neuropathic pain.to rule out the factors here - performing a urine test will help us determine is the pain and swelling is because of the increased uric acid levels and by medication and physical therapy the pain and recurrence can be avoided. For ruling out the vascular insufficiency the Doppler test for both the Lowe limbs will be performed post which is the test is positive - rest, Medication and physical therapy will be advised for better results. You need to use even stockings of lower limbs to ensure the venous return. For the neuropathic pain, your blood glucose levels and MRI of lumbar spine will be guided. Post which based on the possible positive test the treatment will be planned. As due to aging factor - there is even a possibility of lower cardiac output and slower venous return can lead to swelling of ankles. Understanding that the body needs mobility more at this age to allow the venous return to occur and improve the metabolism as well. After a thorough assessment the root cause can be found and post which the treatment will be planned to avoid the future recurrence. RegardsJay In Chat Doctor. 