Hi All,
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I would appreciate any comments/advice regarding a patient with acute forefoot pain. He is a 40y.o runner who has experienced 3 acute episodes of forefoot pain, approx L dors 2/3 mets, while running. He described it as a sharp stabbing pain that caused him to stop running immediately, and he could not continue running. The first episode occured in March, swelling and bruising appeared dorsally immediately, but pain (which was felt dorsally and plantarly), swelling and bruising abated within days and he was "back to normal". He resumed running soon after and had another episode about at month later, which occured in exactly the same manner. However, this time it did not resolve quickly. He had an ultrasound exam the following day, but nothing showed. I saw him a couple of days after the 2nd episode and used some temporary SCF padding to offload the 2nd met, but this was not tolerated. It was painful dorsally and plantarly to palpate and I could also elicit pain with med/lat compression. He has a pl fl 1st ray, and a slightly cavus type foot. All muscle testing and ROM WNL.
The pt went to a sports physician 2-3weeks ago. A bone scan, ultrasound and MRI ordered by the sports physician, were all -ve. The sports physician gave the "presumptive diagnosis of transient synovitis of the 2nd MTP" and administered a corticosteroid injection, asked the pt to rest for 2 weeks, then resume running very slowly. He also suggested the pt come back to me for orthotics.
I saw the pt 2 days ago (he was pain free) and gave him ICB's with a met dome with instructions to wear them in slowly and not to run with them until he was used to the orthoses walking.
He ran for the first time the following day (yesterday, without orth) for only 10 mins and the same acute pain/swelling/bruising stopped him yet again.
I've tried to attach a photo the pt took of his foot following the 2nd episode.
Looking forward to some ideas!
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