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I have a patient with parkinsons getting pain in the metatarsal area and
not correctly walking heel to toe, typical of disease, shuffle walk, etc.
Is there anything I can do ?, would orthotics help ? or is it a postural
problem and requires specialist.

Neil

 

From my lecture notes:

 

I have treated two patients with Parkinson's, who have complained of met pain...on both occasions a neuroma was later diagnosed, using ultrasound. Not sure if this is typical of Parkinson's, tbh, perhaps more experienced practitioners might like to comment.

 

I had the opposite - I started treated a lady for a neuroma and it just would not respond; she reported some unilateral leg weakness and increased fatigue ... turned out to eventually be multiple sclerosis

 

I would start with temporary felt padding to get a feel what will help before making any orthotic decisions.

 

I would think Parkinson's patients can get neuromas, as well as neuroma patients developing Parkinsons.

I don't think you should take the leap to assume there is a cause and effect.

Steve

 

I have found that shoes with a better arch support are helping at the present
time, however he is dragging his feet, which is typical of people with PD I have
been advised. So will have to bear in mind for the future orthotics or padding
first, as suggested, replies are very helpfull, please keep them coming.

Neil

 

Neil:

Since Parkinson's disease is a neurological disorder, then you should probably assume that the shuffling gait is neurological in origin. If the central nervous system can't generate the correct firing pattern for the lower extremity musculature due to disease, then no foot orthosis will be able to allow the central nervous system to perform that function for the patient.

An ankle-foot orthosis for more severe cases or a foot orthosis inside a high top hiking boot may work in less severe cases to allow a more normal heel to toe gait. A neurology consult is a must if the patient hasn't already had one. From your questions, it would probably be best if you asked your friendly orthotist for a consultation on types of braces that could be used by the patient to improve their gait function also. There are some excellent orthotists on Podiatry Arena who could surely help you out with this one.

 

Hi All,

I find a large ammount of the treatment should be done alongside a good physiotherapist by way of gait re-ed.
I find alot of the forefoot discomfort will be associated with the patient developing festination in which the patient will break into a run as their body posture leans forward and they have to keep up with their centre of mass which in turn tends to mean less effective swing and early forefoot strike.

Mark