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I have a patient with bi lateral HAV and bursitis. The HAV doesnt give her any problems but the bursitis is particularly painful for her, she is willing to try anything to reduce the swelling and as a newly qualified pod am strugging to know what to suggest other than protective pads. i would be grateful for any advice

 

Change footwear
Surgery

 

Hi Julie

Bursitis is inflammation of the bursae in response to a stimulus (pressure/friction).

Control by ice and NSAIDS to reduce inflammation. Offload pressure from footwear by padding around, not over lesion. Then check footwear/biomechanics.

Consider that client might wear footwear that you will not be shown.

 

Hi good that you are willing to ask for advice:De
May be worth doing a footwear review with client.
Many people do not understand how there footwear actually works on their feet.
At times they may think it is all fine as the SALES person told them so.
A recent pt had bought 2 pair of elastic slip on shoes that she has had on for some time....disaster!?! corns, ulcerations, bursitis, and she thought she was doing the right thing:bang: sales people had said so.
Pt is elderly at home all day.
Cheapest easiest thing on the day and pt very happy to do was cut holes in them!
Some of the flexible upper shoes are great if there is something to hold them in the back of the shoe eg laces.
( also treated all the other bits of course);)
Cheers lets know how she goes

Cheers

 

Hello again, Julie,

In your original post you said that your patient's bilateral HAV was not giving her any problems - and then added that she was suffering from bursitis!

Busae only become inflammed when they are subjected to abnormal pressures originating from pathological biomechanics and gait. Footwear is the agent, not the cause.

HAV is more often than not concommitent with pronation. Important for the hallux is that one of the components of pronation is abduction. Your patient is almost certainly rolling of the medial (tibial) borders of her halluces, pushing them across in the frontal plane , when they are designed to be sagittal moving.

The remedy? Orthoses to prevent excessive pronation, and this will bring the forefoot into adduction. Best formula? Extrinsic rearfoot and intrinsic forefoot postings.

Just trying to help!