Hi all,
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I'd be gratefull for any advice regarding this patient:
Male, aged 26, works as Phys Ed teacher, plays football and runs.
Was referred to me about 6 months ago from physio for lateral foot pain.
Has shocking feet; lots of rearfoot eversion, midfoot hympermobility, hallux limitus etc...
I made him a pair of inverted style orthoses which have been very succesful, except...
...the problem now is pain and tightness in the middle of his feet that occurs within 10 minutes of running and eases on rest. This has been occuring since he started running in the orthoses and a reduction in bulk under the MLA has made no difference.
Suspecting compartment syndrome I got him to go for a run and on return the middle of his feet was sore and slightly swollen (an area corresponding to the middle compartment). Pain was reproduced on repeated flexion of the lesser digits.
I assume that he has chronic compartment syndrome that has been caused/aggravated by the orthoses.
My questions...
Is there an alternate and/or more obvious diagnosis that I'm missing?
Should I refer for compartment pressure testing or diagnostic ultrasound? (To exclude other pathology before he has the pleasure of a jab in the plantar surface of the foot!)
What should I do with the orthoses?
Is it worth remaking them with an even lower arch before we proceed with further diagnostic testing?
Or are there any magic additions I can pop on to cure him? (clutching at straws here!)
Thanks for any input,
Josh
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