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I have a runner who is experiencing pain after running (...funnily enough) for about 20 mins. Pain is proximal to MH's 2-4 on the left foot and increases with continued running. The patients shoe's are 1 size too big but buying another pair is not an option. They have left gastroc equinus, plantarflexed 1st ray compared to the right. There is also some discs problems L4-S1, though pain described doesnt appear to be neurologically based. There is nothing significant I can see during gait.

So, it seems there may be any number of causes due to compensation of biomechanical abnormalilties increasing pressure on the mid to lateral plantar surface of the foot. Though the proximal position of the pain is unexpected. Also the pain has not previously been present before wearing the shoes which are too big.

Is it a case of fatigue of FDB trying to stabilize the foot in a shoe that is too big?
What can I do in this case, apart from telling them?
What are some differential diagnoses for pain in this area?

Any thoughts on this would be appreciated.

Thanks
Podpup (Probationary Podiatrist)

 

PodPup (love the name)

The main issue with increasing shoe size is that the flex point of the shoe (Toe break) will be moved forward at the propulsive phase of gait . This is usually only relevant in rigid shoes but as the patient fatigues the abnormal dorsiflexion moment on the toes from the shoes could be de-stabilising the MtPjt's.
Assess them during toe raises barefoot and in-shoe and look for gross changes and subjective feedback from the patient.
If this seems to be the problem then either get the shoe modified or try a different style of shoe.

Cheers

Phil

 

Hi There

Try treating the trigger points in: Flexor dig long, interossei, Adductor hallucis (trans and oblique) and Flexor dig brev. These points refer pain to the area you mentioned, and can be treated with deep massage in a" milking "action. I can highly recommend The Trigger POint Therapy Work book Clair Davies.

Joyeux Noel

:santa: