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Hello Learned ones, Long time reader first time poster, and appologies for the long winded post..The problem I have is..
A regular patient, 65 yo 64 kg female who was a regular walker of ~ 8 k,s per day 5days a week up till she had pain in the Right forefoot 12 months ago. No recall of any trauma that would be responsible for the pain. Initial exam pointed to a planter plate trauma of the 2nd, so treatment included rest taping padding. The review was postive so this was continued along with a rocker shoe modification for essential walking only. After about a month it was not improving any more, in fact getting worse, (she was not overusing it). Palpation still had me convinced it was planter plate, just taking time to heel up. So we employed a Cam walker for 6 weeks. This helped quite a lot and the symptoms resolved somewhat. She continued with the modified footwear and limited walking, (has not gone back to ant exercise walking). The area has been manageble for a few months now but has come back with vengence. Arranged an ultrasound which showed "...small effusion and boney irregularities seen adjacent to the 1stMTP joint of the R foot. Planter Plate Tear demonstrated..." "Conclusion.. 1st mpj planter plate tear with small joint effusion, boney irregularity and a small bone spur/ ossicle in the planter plate defect. So What is happening and what can I do with it please ?? Any thoughts or ideas will be greatly appreciated and welcomed. TIA Cheers Brenden.

 

Is the pain on 1st and or 2nd mtpj? Does she pronate/supinate, have ff valgus etc?
Why does she overload the affected structures?