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"metatarsalgia" off the shelf.

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Dan T, May 2, 2023.

  1. Dan T

    Dan T Active Member


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    Anyone got any pearls for a gent suffering with metatarsalgia who can't afford custom orthotics. Lateral STJ, high arch, slight plantarflexion of 1st ray, very little internal hip ROM. Otherwise unremarkable.
    Negative for platarplate/Morton's/synovitis. Simply appears to be generalised inflammation around met heads of right foot as he's heavy set and vulnerable foot type. Was considering heel raise and Poron top cover to correct the slight equinus & cusion. Otherwise I have found this challenging to treat (cheaply) in some larger patients with this foot type.
    Cheers, dan
     
  2. Dan T

    Dan T Active Member

    Was also considering forefoot valgus post but have struggled to add to off the shelf devices with good outcomes.
     
  3. Craig Payne

    Craig Payne Moderator

    Articles:
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    What do you mean by "metatarsalgia"? That is like saying someone has a "sore knee" - could be any one of 100's of things.
     
  4. Dan T

    Dan T Active Member

    Appreciated, however in this instance, it presents as a diffuse ache which gets worse when weight bearing and improves with rest. It is present to all 1st-5th met heads and appears to be a direct response to the prolonged pressure. I have ruled out differentials of Morton's/sesamoiditis/capsulitis/plantar plate with relative confidence and as he can't afford custom insoles he certainly can't afford a scan. I am not trying to use the term as a catch all but in this presentation it does actually sum it up nicely. I imagine there is a more specific diagnosis with elements of synovitis but short of topical NSAIDS I don't think a scan would give me more info to work with for the insole prescription
     
  5. efuller

    efuller MVP


    ?Plantar fat pad atrophy? With lateral axis you can add a valgus wedge with adhesive felt or multiple layers of moleskin. I like Spenco for fat pad atrophy.
     
  6. Dan T

    Dan T Active Member

    Surprisingly not but he is very large so he would need car tyres for fat pads. Have tried the valgus fore foot posts, after reading an article by kkirby with felt, but never seem to get good results. Always get complaints of discomfort so not sure if I'm over doing it or getting the placement wrong.
    Been getting awesome results with felt pmbs, stuck on, with 1st ray cut out and U for 5th PMA ulceration in the cavus foot, however. Healing multiple times faster so all my entry level questioning hasn't been for nothing.
    I'll try the multiple layers and have another go with a varus post though, ta.
    On a completely unrelated matter I just finished reading your coauthored paper on STJ rotation & tissue stress approach, which was great & I got loads from. It states sinus tarsi likely due to h/o severe lateral ankle sprain but also high pronatory moments. Further, that peroneals are disinhibited as increases pain on uneven ground. Is this just a perfect storm following a freak lateral ankle sprain in history or is there something you feel may predispose people with very medially deviated STJs to lateral ankle sprains in some circumstances. I can't imagine that there is, however I have seen quite a few cases more than you would assume these foot types suffer lateral ankle sprains.
    Cheers
     
  7. efuller

    efuller MVP

    A really difficult foot is a foot with a laterally positioned STJ axis and no eversion range of motion available in stance. The maximum eversion height test will tell you if there is eversion range of motion available. If the valgus wedge is bigger than the eversion range of motion available it will be very uncomfortable with high pressures along the lateral column.



    There is a correlation between sinus tarsi and ankle sprain. Why there is a correlation is a good lesson in understanding rotational equilibrium. Sinus tarsi pain is caused by high pressure in the sinus tarsi. Sinus tarsi pain often occurs in a foot that is at pronation end of range of motion and the foot has not everted far enough to get load on the medial column. This will mean the center of pressure is farther lateral than usual and this creates a high pronation moment at the STJ. Further pronation is resisted by pressure in the sinus tarsi. Why the inhibition of peroneal muscles with sinus tarsi pain. Activation of the peroneal muscles increase the pronation moment at the STJ so you need an increased supination moment from the floor of the sinus tarsi (more pain). So if the peroneals are are inhibited when the person does get on uneven terrain and with a single step there is unusually medial force that causes supination at heel contact the peroneals cannot react in time and you get an inversion sprain in a foot that looks like it should have pronation related problems.
     
  8. Dan T

    Dan T Active Member

    Entirely possibly. I do use the eversion test however I am probably guilty of eyeballing it rather than directly measuring. I will start trying again with this and see how I go.

    Ah, got you! It was only that it stated that some, 'believe it is the sequelae of an old inversion sprain', and I was wandering whether it was the chicken or the egg. More likely that early onset of pain leads to peroneal inhibition and thats why these people also have a h/o severe ankle sprains.

    Thanks :)
     
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