Just wondering if anybody has some advice and experience with patients like the one I saw last week in our student clinic:
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Middle aged man who's a keen middle distance runner stated that he has been experiencing generalised forefoot pain after running 15km of a half marathon. He stated that this pain "radiates" to his lesser digits. Otherwise he is asymptomatic.
Examination:
* Cavus foot type (RCSP: 2 degrees inverted both feet, high medial longitudinal arch, prominent hammer toes lesser digits).
* Neutral forefoot to rearfoot position: slight forefoot valgus to both feet (sorry i know i should have measured this angle).
* ankle ROM, STJ ROM, MTJ ROM within normal limits. 1st MPJ ROM slightly hypermobile.
* muscle testing was within normal limits.
* Supination resistance test: easy
* Windlass test activation was normal
* Lunge testing was within normal limits
Gait: observable tibial varum, prolonged lateral weightbearing gait and delayed midstance MTJ pronation.
For this presenting pathology my conclusion was that this patient was experiencing exercise induced neuralgia type pain due to prominent hammer toe deformity and lateral weightbearing gait. I couldn't come up with a specific diagnosis:wacko:
Following assessment I was a bit baffled as to what would be the most appropriate treatment option. As he was symptomatic only after prolonged running my advice was to purchase appropriate running shoes for his activity (eg: general cushioning shoes such as an Oasics Nimbus or Brooks Glycerin).
Should I have prescribed an orthotic for this patient? Has anyone seen patients like mine who have responded to orthoses therapy? My thinking as far as orthoses therapy was to try and keep the patient's feet in their RCSP using a mid-foot customised orthoses, a possible offloading addition like a metatarsal dome proximal to the 2nd-3rd metatarsal heads of both feet; and a low bulk grind for flexibility to the orthoses during running.
If anyone has any advice I would appreciate it.
Regards Tom.
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