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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?

 

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.

Steve

 

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.

 

OK
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.

Steve

 

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?

 

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

Steve