Hi all
Members do not see these Ads. Sign Up.
Any advice on this. I'm confused.
CC: W 30, burning pain only on CM1 and hallux, both sides.
HPI: Pain is worse when playing racketsports. Leather (hard) orthotics with metabar(RCTB, 1-5), relief but after 60m of sports pain is back
PMH: When not wearing orthotics: peronei tendinitis
Sensitive to blisters (proximal to cm1, on the metabar)
PE: //
Musculoskeletal: mild pes cavus. Strong plantar flexed first ray. No forefoot valgus or varus. Normal ankle ROM. Stiff first ray (not much mobility to PF/DF) Rearfoot varus +3
Normal MTP1 mobility. Palpation of fascia is painfull proximal to CM1.
Gait examination: Out-toeing on the left. Slighty supinated gait pattern. Little bit of pronation during loading response. but both feet keep quit supinated. All CM's touch ground at the same time. Groundcontact of toes is late.
No X-rays available.
Cause:
High loading on CM1/hallux because of the plantar flexed first ray and stiff first ray
DD would be sesasmoiditis and flexor hallucis tendinitis
Treatment Plan:
A. Orthotic 40 shore forefoot with kinetic wedge 3mm.
B. Orhotic 40 shore forefoot with RCTB (metabar) with kinetic wedge 3mm.
But rcbt gives her blisters??
C. Orthotic 40 shore forefoot with kinetic wedge 3mm but with forefoot correction???
But my question:
- What would the effect be (on MTP1) of a forefoot varus or valgus wedge (not a reversed morton extension) on a supinated gait with plantar flexed first ray?
A forefoot varus wedge should increase the loading on MTP1 (and the pain) and fascia (witch is sensitive proximal to CM1) but in combination with kinetic wedge, this might work??
A forefoot valgus wedge (not reversed morton extension) should unload MTP1 (if i think about plantar fasciitis)? but it also plantar flex the first ray? Do you want an already plantar flexed first ray to plantar flex more? Will that not increase the loading? But if i think about plantar fasciitis, it does reduce loading on MTP1..
If there was a mobile forefoot valgus would u want to reduce first ray dorsiflexion and midtarsal joint supination? and how?
I'm missing a few things in my reasoning but can't figure it out. Any advice where my reasoning is wrong or short?
Loading...
- Similar Threads - Advice plantar flexed
-
- Replies:
- 3
- Views:
- 12,956
-
- Replies:
- 10
- Views:
- 7,911
-
- Replies:
- 11
- Views:
- 39,693
-
- Replies:
- 3
- Views:
- 1,505
-
- Replies:
- 5
- Views:
- 862
-
- Replies:
- 0
- Views:
- 587
-
- Replies:
- 1
- Views:
- 1,255