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Does anyone have any special magic tricks for treating joplin's neuritis besides the obvious? Cant seem get complete relief with appropriate padding, footwear and orthotics!!!

Any orthotic modification techniques worth mentioning?

cheers

 

Try manipulating the 1st and 2nd met-cuneiform joint and the 1st and 2nd MTP joints, I had a case several years ago with confirmed Joplins and whilst it did not cure the case completely it certainly helped in pain management.

 

Sunny:

Joplin's neuritis/neuroma nearly always responds to conservative treatment as long as you can get them out of higher heeled-tighter toe box shoes and can put them into an orthosis that can reduce excessive STJ pronation moments during gait. Put the patient into an lower heeled running/walking oxford style shoe, invert the orthosis, use a medial heel skive, use minimal medial arch expansion, use a rearfoot post and use an orthosis material that does not deform excessively under weightbearing loads. Sometimes a 2-5 forefoot extension (Reverse Morton's extension) of 3 mm korex also works well with this orthosis for treating this condition.

By the way, Sunny, I don't consider this magic. This is simply the practical application of standard mechanical principles so that your mechanical therapeutic modalities may be optimized to reduce the compression stresses on the medial plantar nerve to the hallux and, as a result, reduce or eliminate the patient's symptoms. Nothing more, nothing less.

What do you consider "appropriate orthotics and footwear"???

 

joplin

Exactly the same as what you do.

In actual fact, my orthotic prescription pretty much matches yours. I have only managed to achieve a 50% reduction in pain so i thought someone may have a better alternative/option to this classical treatment method.

Thanks for your reply.

 

Since this has not worked, then increase the STJ supination moment by either inverting the orthosis further or increasing the stiffness of the medial longitudinal arch of the orthosis. This should help.

What type of shoe is the patient wearing most of the time? What is the sex of the patient? What is their weight? Any special activities? What is the angle of gait?