A patient of mine is a 29 year lady who has high arches and clawed toes bilaterally. Consequently her met heads are very prominent. 10 years ago she fractured her seamoids on one foot (obviously through constant over loading) and had them surgically removed. She has had orthoses ever since, but the pain at the first submet has never gone completely. I made her a new pair of orthoses 12 months ago. They are made from TL2100 with a met dome and 3mm full length spenco cover. I am confident they are controlling her rearfoot eversion. But she still gets pain at her first submet heads bilaterally, particularly when standing for long periods. Playing basketball and following basketball matches she is also in some dsicomfort. The submets are painful to palpate post basketball but not after prolonged rest (first thing in morning).
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I believe there is still too much force going through the first MPJ during her gait. Her forefoot to rearfoot alignment is perpendicular so a forefoot valgus wedge is not indicated.
I know I need to off load the amount of weight passing through the first MPJ to help relieve her discomfort. But I don't want to prevent the first ray from plantar flexing and hence interrupting windlass.
She sternly informed me she doesn't want to have any more surgery on her feet. Does anyone have some suggestions on how I should go about modifying her devices to help relieve some of her discomfort?
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