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Hello,

I have been treating a patient with a small longitudinal tear of the posterier tibialis tendon. He has been wearing this more and more and has been walking 1-2 miles maximum a day. No running or cycling just yet.

He has returned to me with swelling and pain in his third, fourth and fifth toes. He is convinced it is associated with the orthotic. I have since sent him for an ultrasound which has confirmed he has bursitis or neuroma between the toes.

I and the patient believe that the arch supporting orthotic is causing this but I am reluctant to tell him to stop wearing it because he is still trying to heal the post tib tendon.

I have suggested he goes back in the aircast walker for four to six weeks, but this is not a popular choice as it does cause quite a disruption for his employment.

I can also use steroid injection for the bursae but I fear this will only treat the bursae and not the cause of the bursae.

A I doing the right things? Has anyone else experienced bursae with orthotic use?

Thanks

John

 

Hi John

I was reading this and realised it's the same patient as in http://www.podiatry-arena.com/podiatry-forum/showthread.php?t=69526 ? Probably worth asking if the two could be merged again as that had more relevant history.

You're asking if the orthotic could have caused the problems outlined but I reread that thread and realised there was very little info on the biomechanical assessment or orthotic prescription. Therefore it's very hard to comment how the two would interact.

I would say that if a tear to post tib has now been confirmed on US, and the aircast and rice helped reduce symptoms before why wouldn't he want to wear it? Explain the alternatives.

Bursitis or neuroma presumably IM? What factors increase the risk of developing these? How has your orthotic design had any influence on these factors?

Regards
Ian