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HAV Patient Case - HELP!

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Ampodaw, Dec 10, 2017.

  1. Ampodaw

    Ampodaw Welcome New Poster


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    Pt. aged 67, smokes 20 cigarettes a day, BMI 30, sedentary life until recently (on her feet all day, 3 days a week), wears flat slip on shoes and is showing signs of dementia.
    Pt. complains of discomfort under right heel which is worse when walking/standing, and a shallow wound under her right 1st MTPJ which is not healing.
    Presenting with bilateral HAV, +10 right FPI, +9 left FPI, biphasic pulses besides right DP which is monophasic, no ankle dorsiflexion ROM (equinus), 3/5 10g monofilament bilaterally.
    Right hallux abducted and lying beneath 2nd toe which is retracted with PIPJ callus with extravasation. Right 1st MTPJ has plantar shallow ulcer measuring 20mm x 10mm, surrounded by callus.

    My questions are:
    What are the physiological and biomechanical aspects of this presentation?
    What kind of education would you offer this patient?
    What referrals would you make?
     
  2. I would suggest you read Eric Fullers article on the windlass mechanism it will help explain the relationship between the plantar fascia and Hallux Valgus. And should give you some ideas 're treatment options. But remember putting something in a shoe will take up room in the shoe so you need talk to the patient about footwear.

    I would get some xrays and consider referral to a surgeon and talk to the Patient GP about what medical conditions could be leading to ulcers not healing ie DM.
     
  3. davidh

    davidh Podiatry Arena Veteran

    I'm going with a referral to check for diabetes as a first step. For the heel pain she needs to get out of flats and into a small heel. But diabetes would be my no 1 consideration. If not diabetic she needs a referral for weightloss. The HAV is very much secondary in a case like this.
     
  4. efuller

    efuller MVP

    Are you a student putting your homework problem on the web?

    First off the problem is not the HAV, nor heel pain, even if that is what the "patient" asked about. The problem is the ulcer under the first met head. Many things that conservatively treat HAV or plantar fasciitis, could also help reduce pressure under the first met head to treat the ulcer.

    I'm not familiar with your terminology. What is monofilimant 3/5.

    Eric
     
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