Now I have your attention, I was hoping someone out there may have come across what I am about to describe or has at least treated someone with a similar if not the same condition. So let’s start at the beginning.
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Female, 42 years old, slight build and an avid runner. Complaining of Extensor tendonitis L/F with paresthesia radiating into 3rd digit L/F after running 20 mins, does not experience during normal ambulation. Runs 10 miles x3 weekly.
O/E.
Bi-lateral Genu valgum.
L/F @ End range of motion in NCSP excessively pronated in RCSP also. R/F Pronated in RCSP but not as marked as left and still plenty of motion still available at NCSP.
Bi-lateral HAV.
Bi -lateral FF equinus
Functional Hallux limitus
And posterior equinus with 0 degrees achieved upon passive dorsiflexion.
Heavy callous (as one would expect to all MTPJ) Both Feet.
During gait Low gear propulsion observed (patient completely fails to recruit 1st ray during any phase of gait) with early heel raise.
I hope that’s everything, there is quite a bit going on here with this lady so I hope I have described as best I can.
Now to the treatment as this is now symptomatic. I provided her with a 3/4 heel raise and met bar (Well I say met bar but it sits just proximal to the met heads) B/F. Patient returned after two weeks and stated that instead of getting pain 20 mins into her run this had now (after wearing the orthotics) not started happening until 30-40 mins in the run. Now me being clever dicky that I am thought o.k. I will c if we can begin to recruit the 1st ray into gait to 1) make it more efficient 2) stop this low gear propulsion which I feel is the cause to the met pain and extensor tendonitis, so I try a reverse mortons extension. Patient returns to say instead of just the digits dorsally and MTPJ`s hurting her whole foot now hurts?? And experiences some form paresthesia, I mean eh? What, I don’t get it. I am truly perplexed.
Know the question I pose is what do I do now? Do I revert back to the original orthotic I constructed and coupled with the extensive stretching program see how this works or do I look for another solution?
Please any help would be greatly appreciated.
Chris
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