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fit healthy 50yr old who does lots of walking in spare time.

complaining of pain under 5th met head after 2/3 hours walking!!

S/B nhs pods had x-ray which showed " something " under 5th( why dont patients write things down). given what to me looks like off the shelf orthotics with no modifications.

due to time restraints( his not mine) did the quickest exam, very little bio-mechanical abnormalities,

however appears to be ?? tendon? ligament? under the 5th met head which moves from medial to lateral.it seems to "ping" not oedematous or enlarged, not hard ( or soft for that matter)

doesnt appear to be cyst, F/B,H/D, no hard skin. I suspect if there had been any other suspicions the NHS pod whould have identified it.

I'm in mind to make prescription orthotics with a 5th met cut out, and will certainly make a better exam at Xmas ( which is when he comes back to the area).

He is thinking of walking hadrians wall next year , so need to get it right.

Will refer him back to NHS if above my experiance but he is not too keen.

Please, no back biting, I would like some advice only

 

Re: advice please re bio-mechanical problem

Hi Pauline,

The most likely structure is the tendon of Flexor digiti minimi - insertion lateral side of proximal phalanx.

A silicone othodigital wedge in the 4th interdigital space will prevent adduction of the 5th digit and stop the tendon flipping across the 5th met head.

 

Re: advice please re bio-mechanical problem

Pauline,

So what is the structure or tissue that is painful? Is it the tendon that you speak of? The tendons are Flexor Digitorum Brevis and Abductor digiti minimi, interossi, flexor digi longus, there's the adductor hallucis that runs medio lateral and the lateral slip of the plantar fascia.

You can decide which of these are painful and then imagine and reason how it would come to be stressed in terms of the particular foot mechanism of your patient.

regards Dave Smith

 

Re: advice please re bio-mechanical problem

John.

thank you so much.

Thats exactly what the problem is and if I had had enough courage ,I would have said thats what I suspected.

what I couldnt work out was how to treat, A cut out seemed the way forward, yet it didnt feel right.

I take it you mean one of these " gel Toe Spreader" not the thin separator??

 

Re: advice please re bio-mechanical problem

Gel useless for this, Pauline. It needs something forming in Otoform K or similar material. Orthodigital devices need to be anatomically formed in order to function. The wedge must prevent the 5th invading the space beneath the 4th, and be solid enough to keep the 5th toe out of the toe sulcus.

 

My expertise is in discerning the reflex that is causing the stress. My observation is that 5th met. stress comes from opposite shoulder during walking with posture distortion.
During my years of doing therapy I have noted corresponding movements in various parts of the body during walking motion. For the list http://reflexposturology.weebly.com/

Hans Albert Quistorff, LMP
Antalgic Posture Pain Specialist

 

Re: advice please re bio-mechanical problem

Pauline, try a silicone wedge as John has advised, by all means. I would also go down the above road.

Perhaps you could ask the patient to contact his GP to identify what, if anything, was found on x-ray?