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plantar flexed base of 5th

Discussion in 'Introductions' started by m.e. mcgowan, Mar 26, 2010.

  1. m.e. mcgowan

    m.e. mcgowan Member

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    Hello! My name is Dr Michael McGowan and I have a patient with a plantar flexed base of the 5th and in alot of pain. Does anyone have any suggestions to help this patient?
  2. drsarbes

    drsarbes Well-Known Member

    Hi M E:
    You may want to tweak your Dx a bit.
    I've not heard or have I seen a plantar flexed 5th metabase.

  3. m.e. mcgowan

    m.e. mcgowan Member

    I'm not sure what to call it, this pt. has a painful hyperkeratotic lesion under his fifth met base. He has tried orthotics functional and accomadative. 69 yo on his feet all day. On x-ray the base is hypertrophic (plantarflexed). He also has a large HAV deformity and severe HT second with large IPK. Thanks for any help.
  4. drsarbes

    drsarbes Well-Known Member

    This is usually seen in patients with a Lis Francs pathology. I've had luck with a soft
    accommodative insole with a large horseshoe pad around the 5th metabase. These are
    difficult to treat surgically.
    You can accommodate the sub 2nd lesion at well.

  5. m.e. mcgowan

    m.e. mcgowan Member

    thanks, though I have tried this type of padding/accomodation and I haven't seen much on sx. I think bergmann orthotics make a orthotic called balanced inlay, any experience with this?
  6. drsarbes

    drsarbes Well-Known Member

    Hey ME
    It's just when one thinks of Plantar or dorsi flexed in terms of a metatarsal it's usually relative to motion in the sagittal plane with the location of the distal end referencing the position.

    Most of the enlarged 5th metabase patholgy (plantar) I have seen are , as I said, post Lis Francs pathology. Whether the metatarsal is in fact doriflexed (with the base being plantarflexed to it's original position) is up for debate. However, calling the 5th metabase "plantar flexed" in this instance isn't as inappropriate as I first suggested.

    Good luck


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