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I'm looking for advice for orthotic design for a 16 year old female patient I saw with AVN of her 2nd metatarsal head. I am a C. Ped. and received an Rx requsting an orthotic which imobilizes the metatarsal. My idea is to fabricate a full foot carbon fiber orthosis which will provide a rearfoot mechanical correction (sm. rearfoot valgus) and offer longitudinal rigidity. My question is should I fabricate this with a drop\cut out, or keep the metatarsals on a single plane. I'm wondering the long term effects of dropping the metatarsal as she is young and this is apparently life long. Thoughts on long term orthtoic managment?
Thanks for your inputs,
JRADD

 

There may be a difference between what you were asked to do (immobilize the metatarsal) and what the patient needs. If the metatarsal had not yet fully healed from the AVN, the prescriber may have meant to decrease the load on the 2nd metatarsal. Did the AVN change the length of the metatarsal? Is the 2nd met head plantarly prominent? Is there pain with range of motion of the 2nd MPJ. Did the prescriber mean immobilize the 2nd MPJ. Is further treatment beyond the orthothic being considered?

There is a study that showed that a rigid shoe decreased load on the forefoot. So, a full length flat carbon fiber insert for the shoe could do something. However, from the information given, it's hard to make good suggestion.

Eric