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  1. bartypb Active Member


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    Hi there I am after some advice on a pt I am currently seeing in the NHS, a middle aged woman, average weight/height came to see me complaining of a sharp pain to the styloid process L/F, no history of trauma only hurts on weightbearing exercise, and when she goes to her spinning class - after the class she says that it throbs for a few hours. After assessing her there was definate pain on palpation to the stylois process insertion of peroneus brevis, resisted eversion and plantarflexion didn't exarcerbate symps. Rectus feet no mechanical problems noted standing or through gait apart from soft tissue gastroc equinus which I have given strethes for. I belieive that the problem is the insertion of peroneus brevis but apart from inversion stretching can't think of any treatment which maybe able to help - plain films are clear, and lateral posting to offload is too uncomfortable??????

    Any ideas welcome, also If I have missed any information that is required I'll try my best to inform

    regards

    Barty
     
  2. Re: stylod problem

    Barty:

    Try full length rearfoot valgus and forefoot valgus insole wedging or valgus wedged orthoses to increase the external subtalar joint pronation moments acting on the foot. This, along with icing therapy should help. If valgus wedging hurts, try a cam-walker brace boot and cortisone injections.

    May also want to check out her bike shoes for spinning or, even better yet, watch her ride in her spin class. Maybe she is oversupinating on her spin bike?
     
  3. Re: stylod problem

    Check her seat height on the bike - bet ya it´s too high.
     
  4. stephaniepod Member

    Re: stylod problem

    Jones fracture or previous styloid fracture, these are often missed on radiology reports
     
  5. nigelroberts Active Member

    Hi Barty
    Just a further thought. Could it be painful os peroneum syndrome? Accessory ossicles are often unreported as they are considered a normal finding.
    Nigel
     
  6. Shane Toohey Active Member

    Hi Barty,
    I'd also like to mention releasing triggers in the peoneals as a way of quickening the response to mechanical interventions. It's a very conservative treatment.
    In regards to the problems with the lateral wedging I'd suggest that you may need to just miss that part under the styloid if it is very tender (ie deflect off that spot) as it will be vtail to negate that lateral instability. The replies about adjustemnts to cycling positions sound like they know what they are talking about.
    Cheers
    Shane
     
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