Hi All,
Members do not see these Ads. Sign Up.
I have a case I would love some advice about. Pt has been putting up with pain for over 7 years as multiple specialist attempted diagnosis but they basically did nothing for her. I started seeing her 6 months ago.
Patient Information:
Female - mid 30's
Diabetes T1
Works in retail standing long periods of time in R.M. Williams boots
Patient Complaint: RIGHT FOOT
Multiple Intermetatarsal Bursiitis
1st/2nd
2nd/3rd
3rd/4th
Interstitial Bursiitis 5th
Symptoms:
Initial: 7-8 Years ago, patient felt a sting and then her foot swell up. No treatment provided and was off work for one year.
Current:
Pain on WB and worsens the longer she is WB. At work is worst.
Foot feels hot and burns.
Valiex sign from forefoot to posterior knee
Foot feels tight and restricted
Foot Function:
Mulders Click - Positive
Retracted toes due to compensation pattern of patient to try and walk on the side of her foot to reduce pain
EDL 3rd-5th Digits - little to no movement upon active attempt, can be passively moved (I do have a video demonstrating this)
Rearfoot and Midfoot ROM normal
Ankle Joint ROM: Reduced by not restricted. Muscular tightness.
Gait Analysis: Difficult due to antalgic gait. Lesser toes do not WB/ load due to forefoot swelling.
Treatment:
Metatarsal Dome and Metatarsal Pad trialled with and without orthotics. Both caused increase in pain despite multiple attempts at positioning.
Footwear: Advised wider fitting shoe to reduce pressure. Any enclosed shoe causes pain. Thongs not so much, but still is uncomfortable.
Calf muscle stretches prescribed
Anti-Inflammatories
Soft rubber ball massage to reduce soft tissue tightness
None of this worked.
Cortisone Injection into the two largest bursas with 1 week rest from work with the use of crutches was recommend. Crutches were unable to use due to shoulder injury. Complete rest - was not entirely compliant while off work.
It has been 2 weeks since the injections and I have the feeling that her results have been minimal.
I have suggested to the GP that surgical intervention may be required if pain does not subside. She saw a GP (not her regular GP) who advised her that he does not think surgery will go ahead and that all she needs to do is to improve her forefoot biomechanics by performing stretches to reduce retracted toes.
What do you all think?
Any helpful advice is very much appreciated! :)
<
Genetic risk factors for plantar fasciitis
|
The Role of the Paratenon in Achilles Tendon Healing
>
<
Genetic risk factors for plantar fasciitis
|
The Role of the Paratenon in Achilles Tendon Healing
>
Loading...
- Similar Threads - HELP Multiple Intermetatarsal
-
- Replies:
- 0
- Views:
- 191
-
- Replies:
- 0
- Views:
- 98
-
- Replies:
- 0
- Views:
- 275
-
- Replies:
- 3
- Views:
- 1,087
-
- Replies:
- 3
- Views:
- 689
-
- Replies:
- 0
- Views:
- 616
-
- Replies:
- 0
- Views:
- 452