Flexor tenosynovitis

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Hi,

Anyone heard of flexortenosynovitis affecting the feet?
I've got a patient I've been seeing for a while. They have psoriatic arthritis , nephritis, COPD and fts in the hands. He saw a consultant recently who's told him he has the condition in his feet as well: patient said he's been having a lot more pain and cramping in his feet over the last couple of months so it makes sense.

Thing is - I've not heard of it affecting the feet before: is it common?
He comes regularly for debridement of fibrous HDs - he did see a bio "specialist" in our department who prescribed total contact insoles that he doesn't wear as he didnt' find them comfortable.
If we can get footwear to accomodate, I'm tempted to try again but using a fairly soft material he can "bed into" such as low density EVA - does that make sense?

Anyway, I'm wondering if there's a way of addressing the flexortenosynovitis at the same time, probably using said orthosis.
Also wondering if other people have come across it affecting the feet as this is a first for me.

cheers.

 

Re: Flexortenosynovitis

The flexor tenosynovitis is probably part of psoriatic arthritis.

Doubtful orthotics would have any effect. If it is psoriatic arthritis, they need some biologics from a rheumatologist.

 

Charlie:

Flexor tenosynovitis means that one of the flexor tendons sheaths (i.e. either the flexor hallucis longus or flexor digitorum longus tendons) of the foot has more fluid in it than normal, usually due to inflammation. It is a common diagnosis/finding on MRI scans now. Flexor tenosynovitis may be due to trauma or it may be systemic in origin. Common treatments include rest, oral non-steroidal antiinflammatories, bracing, orthoses and physical therapy.

Hope this helps.

 

Hi Charlie,

I would bet that its possible to overstress any tissue in the body. One hypothetical cause of flexor tenosynovitis is having painful HD plantar to a metatarsal and the patient then uses the flexors to increase toe pressure to decrease pressure under the metatarsal that is painful. If this were the case you would expect to see gripping with the toes in barefoot gait. Or evidence of gripping with the toes with impression in the sock liner of the shoe. If pressure was reduced under a painful metatarsal the patient may reduce their flexor activity. That said, if a well made total contact orthotic didn't help then I would certainly blame the rheumatiod arthritis.

Did you ask why he does not wear the inserts?

Regards,

Eric