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Navicular and 4th met stress fracture treatment

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Mark Whiteside, May 5, 2008.

  1. Mark Whiteside

    Mark Whiteside Welcome New Poster

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    I have a female patient (59years) coming in tomorrow who has recently been diagnosed with the following:
    -stress # base of 4th met (L)
    -fracture or stress # anterior process calcaneus (L)
    -navicular stress reaction (R)
    -plantar fasciitis (L).

    She has an underlying neurological condition resulting in weakness and myopathy (mild muscular dystrophy has been ruled out).

    Of concern, is what to treat? I appreciate this will be based on my assessment tomorrow but was wondering if anyone has some suggestion in terms of treatment.

    Would a cam walker be the best treatment for the (L) conditions? If so what interim treatment should be provided until the Cam Walker can be oredered in?

    Also due to the navicular being a stress reaction would offloading be enough?

    Any assistance or advice regarding determining whats of most importance and the best treatment would be appreciated.


  2. DaVinci

    DaVinci Well-Known Member

    I would start with a total contact orthotic

    BTW, did you see the news tonight in Melbourne about a footballer with a neuromotor deficit (from previous surgery for a compartment syndrome) fractured the 4th metatarsal.
  3. Adrian Misseri

    Adrian Misseri Active Member

    G'day Mark

    I'd have the left foot immobilized immediately, being that there is so much osseous damage in high pressure areas. Camm walker would probably be best as this will allow the patient still to ambulate and shower and sleep normally. I use lots of them and usually have a couple at the clinic that I can hire out. If you head up to your local aids and appliances department of your local hospital they should be able to give you one on the spot at a reasonable price. If you have to wait for one, crutches and NWB for the left foot definately. Fractures to the base of metatarsals are such difficult thinsg to treat and realy need t be managed properly otherwise they can develop into long standing issues. As for the right foot, I'd probably use some shoe padding initally to offload direct presure form navicular, either through a set up similar to a total contact device, or even a huge arch cookie with a divot/apeature under the navicular. What you really need to stress is that the patient HAS TO rest. and when she is on her feet, maek sure she isin runners or something with really good shock absorption.
    What is the mechanism of injury in the left foot? The neurological disorder shouldn't affect bone density, but if the patinet has altered mechanics from the neurological disorder, abnormal gait patters will need to be addessed. Also be sure to look at patinet lifestyle pattens and social/family habits. I'm manageing a similar sort of patinet that has bilateral metatarsal shaft fractures, and she is not sure how she did them. It's an interesting case as the patient suffers from anxiety, and it seems that she has fractured the left foot rushing around doing family things and running arudn after her 16 year old daughter, and then did the right foot rushing around favoring the initial fracture. Just make sure you address the bigger picture overall, not just the injury.

    Cheers and good luck!

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