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Flexor hallucis brevis tendonitis

Discussion in 'General Issues and Discussion Forum' started by I-pod, Feb 14, 2009.

  1. I-pod

    I-pod Active Member


    Members do not see these Ads. Sign Up.
    what is the main treatment methods for flexor hallucis brevis tendonitis?

    Are there any effective conservative treaments? the subject appears to have inflamation of the 1st mtp joint- as well as arthritis in this joint, but no sesamoid pain, and does not have any fractures of either sesamoid either. Thanks for listening to me; I-Pod.
     
  2. bkelly11

    bkelly11 Active Member

    Offload the Tendon, differential Gout??

    Could try taping, fan strapping, Shaft pad attached to OTC insole. R.I.C.E.

    Whats the Hx of injury??
     
  3. How do you know the injury is to the flexor hallucis brevis tendon?
     
  4. I-pod

    I-pod Active Member

    the flexor hallucis brevis tendon is clearly the one causing him pain. i asked him to get an MRI scan but said he had to wait for 6 months. would an mri scan be of much use. he has been walking on the tendon for a long time now, so i assume it is not ruptured. i am considering cortisone shots but the patient has been suffering from pain for over 2 years now, so am thinking perhaps surgery maybe best suited for long term success. i have x-rayed the sesamoids and they present no fracture.
     
  5. I-pod

    I-pod Active Member

    how can u offload the tendon with padding b-kelly. i am sure it is not gout too. pain is only present from walking
     
  6. I-pod

    I-pod Active Member

    also i thought heat was better than ice for tendon inuries after 48 hours?
     
  7. I-pod

    I-pod Active Member

    the subject fractured their fiblua and after coming bak into sport started developing what he described as arch pain. i think this was a general swelling but now the pain is very much focussed on the FHB tendon and mainly at its insertion to the sesamoid bone. i have never come across this problem before? all help is very much appreciated!
     
  8. I don't know clinically how one would determine that the flexor hallucis brevis tendon is the exact injured structure since the flexor hallucis brevis tendon is deep to the plantar aponeurosis and the flexor hallucis brevis, plantar aponeurosis, adductor hallucis and abductor hallucis tendons all attach to the sesamoids. Please tell me how you clinically determined that the flexor hallucis brevis tendon was the structure injured since I don't know how to perform this clinical determination technique. Are you sure what you are dealing with isn't a tear of the distal insertion of the plantar aponeurosis into the medial or lateral sesamoid?:confused:
     
  9. I-pod

    I-pod Active Member

    i am not sure kevin- i think i am going to request him get an mri scan before porceeding. if it was a distal tear of the plantar aponeurosis what is the treatment method? the individual in question has football trials at the club chelsea coming up in less than a month, and i really dont know what to say to him. thanks.
     
  10. My guess is that the patient has a small tear in the distal insertion of the plantar aponeurosis into the sesamoids, not a "flexor hallucis tendinitis". Try icing 20 minutes three times a day, using a varus heel and medial arch pad/orthosis along with a reverse Morton's extension and/or a rigid sole plate at the 1st mpj to prevent shoe sole flexion at the 1st mpj. Using a low-Dye strapping with a reverse Morton's extension applied to the foot help quite a bit in athlete's such as this. I don't normally perform an MRI on these patients unless there is a lot of eccymosis or localized swelling.

    Hope this helps.
     
  11. I-pod

    I-pod Active Member

    appreciate the help kevin- could u recommend any good orthotics plz
     
  12. I-pod

    I-pod Active Member

    and how would i be sure this is the problem
     
  13. drsarbes

    drsarbes Well-Known Member

    Hi iPOD:
    I think it would help if you gave a bit more information on the clinical picture.
    For instance, you state this patient has pain at the insertion of the FHB at the sesamoid but no sesamoid pain. Inflammation at the 1st MTPJ but pain is at the proximal sesamoid, but the sesamoid is not painful.

    Somewhat confusing.

    Steve
     
  14. I-pod

    I-pod Active Member

    also what is the best way to apply ice in this circumstance.
    i really do appreciate your help on this matter. the subject i am trying to help is actullaly a relation to me and i mainly specialize in biomechanics and not many uk podiatrists i know have any idea of this injury. american podiatry is advanced and know where it's at lol.
     
  15. Are you a podiatrist, health-care professional or a patient?
     
  16. I-pod

    I-pod Active Member

    pain at the proximal sesamoid? where did i say that dr sabres?
     
  17. I-pod

    I-pod Active Member

    bit of both
     
  18. I-pod

    I-pod Active Member

    kevin man if u help me and i get into chelsea i will give u the biggest pay cheque of your life
     
  19. I-pod

    I-pod Active Member

    just tried the ice bath well cold!
     
  20. I-pod

    I-pod Active Member

    i have a fascination in feet- i play semi pro football- though am on the books for chelsea and aston villa- the pain is nt on the sesamoid bone at all really. the pain i thought was the fhb tendon mainly occuring at its joining to the sesamoid bone.- like just an incy bit before the bone. but the bone i wouldnt say really hury
     
  21. I-pod

    I-pod Active Member

    heat or ice for chronic tendonitis

    What is considered better. its is for tendonitis of the foot- either distal plantar fascia or flexor hallucis brevis tendon. thanks for listening I-pod.
     
  22. I-Pod:

    I can feel for you since I was a competitive athlete in my younger days and was often sidelined with injury. Your best bet, as a patient, is to let us know where you live and/or where you can travel to for treatment, and I'm sure the good clinicians of Podiatry Arena can direct you to the best qualified sports podiatrist/clinician in your area. Normally, though, Podiatry Arena is not for patients to ask questions about their own problems. However, in your case, since you have done a little studying of anatomy, I think you deserve the benefit of the doubt.

    And by the way, save your money for your treating clinician....I'm just suggesting possible treatments for the many possible diagnoses that you may have...and normally, I won't give out medical advice to patients over the internet, unless I have first personally examined them.

    Good luck with your football career.:drinks
     
  23. I-pod

    I-pod Active Member

    thansk Kev- i live in Windsor(UK)- i have been to a fair few podiatrists around england who have all been very unhelpfull- they have all said something different with no real conviction. they have given me various orthotics all with no success- but some did help initially, which was most likely the padding. in fact all helped for the first few days to some extent. but padded ones helped more. would an MRI definately diagnose my problem. i have been to the so called podiatry experts and it was a surgeon who after making me purchase 300 pound orthotics as well as several consultant appointments decided it was the flexor hallucis brevis tendon to blame. i then had 3 lots of cortisone injections over 6 weeks which he said would definatley cure it. the injections provided no relief what so ever. this guys comes from a recommendation from another podiatrist who said this guy know everything and would cure it for sure. i cannot belive as well as everyone else how long its taking to even get a clear diagnosis.
     
  24. bkelly11

    bkelly11 Active Member

    Thinking of splinting the 1st MPJ to Ruduce the movement at the joint allowing time for the damaged structure to heal I-POD.

    Good luck with the trials. Chelsea!! Get up to Glasgow mate if your any good!!!!
     
  25. Tim Foran

    Tim Foran Active Member

    Most of the people on this forum would also appreciate a bit of honesty up front.
     
  26. I-pod

    I-pod Active Member

    how on earth do i do that(the splint)- will i be able wo walk lol. yeh i wouldnt mind playing for anyone atm tbh. i did my first trial with the injury when i was no where near fit and they asked me back. but am afraid it has got a bit worse with time. so really need to just fix it now. Thanks alot.
     
  27. I-pod

    I-pod Active Member

    looked at that reverse mortons extension- is this not opposite to splint technique.
     
  28. I-pod

    I-pod Active Member

    do they both reduce movement of first mtp. very confusing- honesty has never gotten me anywhere. the other week i was honest and got kicked off lol dont tell twirly plz- this thread is best chance i got
     
  29. drsarbes

    drsarbes Well-Known Member

    I-POD:
    Do us all a favor and take this patient (or relative) and tell him (or her) to make an appointment and get some professional help. Although you may be well meaning, I do not think you're helping this person.

    I'm afraid that any advice you may receive here, although well meaning and from some very well trained individuals, will not be any better then the level of information and interpretation you have supplied us with.

    I hope I've been diplomatic enough.

    Steve
     
  30. bkelly11

    bkelly11 Active Member

    Speak to the club. They will be able to point you in the right direction re-care.

    Splint, Taping or reverse mortons. You need to see a specialist and a club like Chelsea will probably have the best.

    Good luck
     
  31. cpoc103

    cpoc103 Active Member

    IPOD,

    You seem to be a nice chap and I feel for youl, my rugby career was ended when I broke my back. As a podiatrist practicing biomechanics and as a sports enthusiast, take your self to harley street in London and seek some professional help, or if you are willing to travel you could see a chap called Paul Harradine, he is down in Pompey very very good-- company the chiropody and podiatry centre.

    good luck.
     
  32. I-pod

    I-pod Active Member

    ur a cheeky so and so Colin. he belongs to parish and bell and is trying to con everyone. you luky u didnt mess with me, believe me on that 1. and tell les to get a life
     
  33. I-pod

    I-pod Active Member

    hi ya kev/bkelly, i was just wondering if you could please help me out on something. I visited a consultant yesterday who had ordered a scan of the area and said nothing was wrong.
    I am sceptical that all is alright however. i can visibly see a tight tendon/fascia on the sole of my right foot which appears tightest at the connection to the sesamoid area. My left foot is fine however and displays a much more relaxed tendon with no pain/tenderness. I pointed out this comparison to the consultant but said it was normal. whenever a health practitioner pokes around over the surrounding area, i do not feel any pain. i feel the pain is only brought on by walking, which makes the area hot and inflammed.

    I actually spent 2 weeks on crutches just prior to the visit yesterday to the consultant for the results, but after being made to look like a fool/drama queen by both the consultant and mother was stripped of them. after walking for a while and kicking a football running on adrenaline and pure defianace I did not experience any pain or inflammation as I had previously encountered before the crutches period just a few weeks ago.
    I also iced the area alot during the 2 week immobilistaion period. i am wondering if this info sounds familiar.
    can I also add one more thing; when i saw a podiatrist a while back he attempted to reduce pressure from my sesamoid bone area by using the typical doughnut pad in the hope to reduce pain. this pad actually brought the pain on instantly as the pad was covering the painfull area. Is there any way i can reduce the area from the part just before the sesamoid area using a similar padding technique that is known to help. ( i know the obvious is to cover the surrounding area) but am confused. Thanks for help- this is last note i hope!
     
  34. drsarbes

    drsarbes Well-Known Member

    "...........after walking for a while and kicking a football running on adrenaline and pure defianace I did not experience any pain or inflammation as I had previously encountered before the crutches period just a few weeks ago."

    Guess you're cured!

    Steve
     
  35. I-pod

    I-pod Active Member

    oh hahahhha drsarbes. adrenaline as you should very well know is a temproary effect. i had no pain after my scary adrenaline levels reduced to what i could only describe as mere hulk agression.i am actually thinking of pursuing a career in medicine if pro football fails, as i think a specilaist consultanty role in the NHS would allow me too watch all the footy anyway(if not participate), make a tidy sum similar to a lower league player would, whilst maintaining a good social identity, and the choice of going out on the royal raz every weekend and drugs every other. oh how i envy these medical experts they claim to be of something...... I'm sorry to say people but the parish and bell case is what exactly what most other health practices are doing- running a business and targetting an extremely easy audience.its a very good trade to get into; as you are always right and the customer is very rarely. i honestly say folks live with the pain- adapt if needs be but from my many experiences in this field as well as other health related fields you are more likely to be given incorrect/poor advice from someone you believe had been mentored by someone equivalent to the great RICHARD DAWKINS when in reality is no smarter or able than the average paris and bell 'customer'. its time truth and pure defiance is shared and so i part fair well; but urge thee to spread the word, far far across the land. i mean drsarbes is that just your name or are you really a doctor. i hate the indian doctors the most they so god damn shifty. would like to name and shame but simply cannot remember a 12 long sequence of seemingly random letter- mostly vowels, which they use in our country ENGLAND! if you live in England you should have an English name. i think fcuk u and ur politics and bring me back to old school where i can jam with my hoomies and smoke a reffer without a brother asking about my willy.
     
  36. Griff

    Griff Moderator

    I-Pod

    Sounds like you would have made a model pro... I think our Premiership can do without players like you...
     
  37. I-pod

    I-pod Active Member

    Ian my will hurts
     
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