Hi everyone,
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We have a patient, (61 year old very active female bushwalker), that is responding really well to orthotic treatment (history of 2nd MPJ capsulitis, 3rd & 4th MPJ degeneration, ankle instability, navicular stress reaction, ankle instability, calf cramps - all now going great with orthotics)... except for one residual problem... she is complaining of increased pressure under hallux (right worse than left), which is causing pain and blisters.
For those interested:
Her biomech assessment revealed: hypermobile cavus foot type, severe level of increased ankle joint dorsiflexion stiffness (equinus), extreme grading of supination resistance, short 1st metatarsal (4mm bilaterally) with long 2nd metatarsal (right foot only, 2-3mm), everted forefoot (5 degrees bilaterally), 6-7 degree inverted NCSP.
So basically, she has the influence of 3 major factors responsible for increasing MPJ1 stiffness, ie. high pronation moment at subtalar joint, increased dorsiflexion moment at forefoot and increased plantar flexion moment at rearfoot.
On review this morning, the orthoses looked great, good conformity, apart from mild gapping at the anterior MLA. Jack's test was again performed, and the result was early onset, high force.
What else can be done to reduce the force at the 1st metatarsophalangeal joint?
These things have helped her:
- metatarsal dome
- MLA support
- medial heel skive
- plantar fascial accommodation
And other things that we know can help (but this patient cannot tolerate) are:
- forefoot valgus wedging
- rearfoot varus posting
Does anyone know of anything else that can be done to decrease the force at MPJ1? Is it worth increasing the depth of the plantar fascial accommodation to see how this helps? :confused:
Thanks for your help!
Regards
Donna ;)
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