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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

 

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.

 

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

 

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.

Cheers,

Eric

 

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.

 

And the same can be seen around the Navicular in medial deviated axis. Wolfs law at work I guess.

 

Good stuff guys

thanks
Dave

 

Cut out the first ray!

 

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

 

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!