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Painful toe pt enquiry

Discussion in 'Biomechanics, Sports and Foot orthoses' started by new qual pod, May 1, 2007.

  1. new qual pod

    new qual pod Welcome New Poster


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    Hello fellow podiatrist
    I,ve recently had a female 25yr old underweight patient who presented with painful unilateral 2nd toe which began 4 months ago and now the pain is extending into the ball of her foot and her arch. She has psoriasis. An X-ray showed flattening of the 2nd met head with widening of the joint space. Ive considered Freibergs, but am aware this is a juvenile condition and would appriciate some feedback.
     
  2. Peter

    Peter Well-Known Member

    No, Freibergs is common in juveniles, but can occur at any age. In the past 3 weeks I have picked up 2 Freibergs , both females in their 40s. Also consider psoriatic Arthropathy, but it sounds like Freibergs.

    Put her into a POP immoblisation cast to reduce further joint degeneration
     
  3. W J Liggins

    W J Liggins Well-Known Member

    Also consider differential Dx including psoriatic arthritis/arthrosis, capsulitis, stress # (the Xray may not pick this up until resolution begins to occur) neuroma and functional problems. Much depends on the Hx and physical.

    All the best

    Bill Liggins
     
  4. David Smith

    David Smith Well-Known Member



    What then peter? Is it best to use a strategy that will reduce dorsiflexion moments about the 2nd mpj e.g. Orthoses, a rocker shoe, perhaps a met bar along the 2nd shaft. I have had quite good sucess with this strategy. Might surgery be a consideration?

    Cheers Dave
     
  5. moe

    moe Active Member

    Plantar plate rupture?

    Can you post the xrays?

    Iona
     
  6. Peter

    Peter Well-Known Member

    Code:
    What then peter? Is it best to use a strategy that will reduce dorsiflexion moments about the 2nd mpj e.g. 

    Dave,
    A rocker sole modification, or if the pt has a pair of walking shoes with a stiff midsole and forefoot rocker, that often suffices.

    I also get some shoes stiffened with a carbon-fibre plate added into the midsole if the shoe permits it eg Classic style trainer.
     
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