Hello,
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I am just seeking everyone's wisdom and advice regarding one of my patients.
Clinically, she has pain on palpation in the 3/4 webspace, with direct force on 2 & 3 plantar plates, as well as pain in the lateral aspect of the 5th MPJ with compressive force.
She is also complaining of numbness on the medial hallux & the dorsum of the foot.
In weight bearing - she experiences diffuse pain on the plantar forefoot region - no one area is localised as being more painful.
If she 'takes her weight off the outside of her foot' (everts), she experiences less pain.
If I invert her foot, she experiences pain along the lateral aspect of her foot.
In a relaxed stance position, her heel bisection is approx 6 degrees everted.
She has a high arched foot in non-weight bearing, but displays excessive midfoot and rearfoot pronation during gait.
Her forefoot is inverted relative to the rearfoot.
According to the ultrasound, she has:
- plantar plate tears in the 2nd & 3rd plantar plates
- 3/4 Morton's neuroma/bursa complex
- adventitial fat pad changes
I am just looking for suggestions regarding her orthotic prescription. Obviously I am needing to address all the different pains she is experiencing! I am confused as to how I should use met domes and/or u-padding in order to offload the lesions without increasing pressures on adjacent lesions!
A met dome in the 3/4 space has only increased her pain. She finds high heels to be more comfortable than flats (in the forefoot) - she finds that sneakers make the pain worse. Any shoes that allows her foot to 'splay' makes it worse, while narrow shoes make it better (?!).
She wears high (5-8cm) heels every day. She is very resistant to wearing more appropriate footwear.
The only thing she has found to be helpful so far has been low-dye strapping - but she is very sensitive to anything applied to her skin for more than a couple of hours.
Any advice anyone can provide would be great.
Thanks in advice,
Sarah.
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