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Enlarged styloid process

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Dec 29, 2009.

  1. David Smith

    David Smith Well-Known Member

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    Dear all

    Just today I had a customer phone for a review because he has a swelling of the 5th metatarsal base / sygmoid process a few months after fitting orthoses. They are custom Amfit EVA construction but I had one case the same once before with a pair of vasyli OTC. The previous case was resolved by not using the orthoses, just reducing pressure on the area did not help. I haven't seen this latest guy yet but the last one I could not identify any reason for this happening. Any thoughts? Scan of orthoses design below;


    Cheers Dave Smith
  2. Dave:

    You should take your patient's name off your attachment.

    Sounds like insertional tendinitis of the peroneus brevis. Try everting the orthosis and/or adding a valgus forefoot wedge to the orthosis.....this generally works quite well for such symptoms.
  3. David Smith

    David Smith Well-Known Member

    Crikey Kevin! you were quick, noticed that error straight away and edited it tout suite but you had already posted. I'll try what you suggest, thanks.

    Cheers Dave
  4. efuller

    efuller MVP

    Other causes of pain in styloid after orthotic usage include: lateral column overload and the foot sliding laterally over the device so that the edge of the device digs into the plantar foot.

    Looking at the device printout it appears that there is a significant medial heel skive and there is significant thickness under the lateral forefoot. Too much skive could cause the peroneal tendon isertion problem that Kevin described. Too much thickness under the lateral column would cause the plantar overload. The patient may be able to describe when the pain occurs to better help you differentiate between the two. Everting the device could increase pain from lateral column overload.


  5. Dave,
    I agree with Kevin and Eric. In addition, I've noted over the years a relationship between enlarged styloid process and laterally deviated STJ axes.
  6. And the same can be seen around the Navicular in medial deviated axis. Wolfs law at work I guess.
  7. David Smith

    David Smith Well-Known Member

    Good stuff guys

  8. Graham

    Graham RIP

    Cut out the first ray!
  9. Seems a bit extreme to remove the 1st met from the patient with an enlarged styloid process, I mean its pretty big surgery.

    Just Joking Graham though I´d make a funny. I understand what your saying
  10. Graham

    Graham RIP

    You know it might work. Would definately de-stabilze her medial column and off load the lat aspect!!:dizzy:

    Maybe it's a good thing I don't do surgery!

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