Hi,
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Was wondering if anyone had some recommendations for me.
A patient I am seeing sustained a 1st metatarsal communited fracture in a car accident. Initial management included casting and cam walker. He presented to me 12 months later with the following pain.
-1st metatarsal shaft pain
-2nd MTPJ pain = greatest site of pain
-1st inter metatarsal space pain
Most of this pain is during propulsion/at toe off
Recent x-rays show a shortened 1st metatarsal, dorsiflexed 1st ray and some mild spurring which seems to enter the 1st interspace.
The previous Podiatrist prescribed some custom orthotics which have helped a little. Dynamically rearfoot is overcorrected with late midtarsal joint pronation to compensate. I have tried a single wing plantar cover which increased his symptoms slightly. Now I am trying a U 2nd plantar cover. My other thought was to try a 1st met shaft pad.
Any suggestions or should he seek a surgical opinion.
thanks........
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