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HI all I have a patient who presents with left dorsal foot pain.

Pt is female in 50s and is on feet all day.

Painful upon dorsi and plantar flexion.

Applied rigid taping to provide additional support. Some relief. Not much.

Imaging shows:

Left foot US:

Synovial thickening and degenerative changes are present at the 3rd tarsometatarsal joint.

There is evidence of Inter-metatarsal space bursitis 2nd & 3rd IM spaces. No neuroma identified.

XRay Left foot:

There is Minor joint space narrowing at the 3rd tarso metatarsal joint.

There is no focal lesion of bone or fracture.

In conclusion:
Inflammation of bursitis probably due to chronic trauma possibly from standing and lack of cushioning in footwear and reduced healing due to age.


I advised pt to wear CAM walker to reduce movement and pain.
Pt found CAM walker reduced pain progression, but made hip very sore. (due to compensation).

Told pt to remove CAM.

Pt has been using Hot/cold water to reduce pain.

Advised pt to wear rocker sole to see if that helps. will Rv this.

Thinking of further treatment options to reduce motion in feet and allow feet to heal.

Ongoing taping, wheelchair for a time.

Stem cells thrapy?!

Have you dealt with this sort of thing before?

Please suggest what you think could help my patient?

 

I like a lot of your interventions here. You'd think a rockersole would mimic aspects of CAM, so likely to help.

Did you have contralateral heel raise for LLD changes caused by CAM?




Your assessment, conclusions and treatment is very thorough; but in my opinion, it is too pathology-based (assessment). Sometimes you can have similar pathologies that benefit/worsen with a particular intervention. Take one step back from pathology-based assessment and spend more time on what it likes/dislikes. I think that will get you closer to the solution.

If all that conservative intervention doesn't work, your WCS option down-the-track is your typical guided injection.



RB

 

Thank you. Ronnie.
You have made some great points.
I will be able to help my patient more thanks to your advice.