Hi everyone,
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Had a really interesting case enter the clinic recently and thought i'd share it with you. I would greatly appreciate any advice, had difficulty deciding where to start!
38 y/o female, unbearable forefoot pain for several months however has had general foot pain for years. Works in retail, 10-12 hour shifts on concrete floor. Footwear not great, no cushioning, slight 1-2inch heel. Rated pain as 9/10 on VAS, no refielf of symptoms unless resting completely.No hx of inflamatory arthropathies
Clinical assessment: forefoot swollen, plantar and dorsal, very painful on plapation of all plantar mets, inter-met space, dorsal and plantar pain. Ordered x-rays to investigate inflam arthropathies, OA, Joint boney injury. Results all normal appearance. Then ordered US, now it gets interesting!!
Right 1st - full thickness plantar plate tear, appears long standing, joint effusion but no bony irregularity
R/2nd - 5mm plantar plate tear (PPT)
R/3rd - 2mm PPT
R/4th - 6mm PPT
R/5th - 4mm PPT, joint effusion noted, no bony irregularity
R/3rd inter-met space - Morton's Neuroma
Left 1st - joint effusion, no bony irregularity
L/2nd - 4mm PPT
L/3rd - 1mm PPT
L/4th - complete PPT
L/5th - 2mm PPT
L/2nd intermet space - prominant bursitis, extending to platar fat pad
L/3rd intermet - Morton's neuroma!!!!
It is unbelievable this woman can even stand! Have been padding and strapping her feet to offlaod and dorsiflex all mets, advised on footwear.
Can't stop going to work as feels they need her now as it's so busy.
I am referring on to surgeon, organising G.P to provide work leave. No point in custom orthos at the moment until Sx gives his opinion.
Will continue padding/strapping/offloading short-term.
Any other suggestions??
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