Hi All,
Members do not see these Ads. Sign Up.
I evaluated a 180# female gardener yesterday who spends a lot of her day in a full squat, toed out, with heels on the ground weeding gardens. Her symptom is tingling in all her toes, esp. 2 and 3, and in the soft tissue between her met heads and bases of toes when in this full squat position. She is less symptomatic, however, if in Crocs than if in a supportive hiking shoe with a wide toe box. She also gets the symptom when driving and walking when foot wear does not make as much difference. Her presentation is as follows on the left symptomatic foot:
RCS: vertical
Arch ht: low
STJN: 20 deg calcaneal varus
Forefoot: neutral
Joint mobility tests: restricted distraction at talocrural joint and restricted A/P glides at calcaneocuboid and talonavicular joints
Muscle length: short gastroc/achilles in STJN
Special Tests: positive anterior drawer and varus stress tests at the ankle
Palpation: Pain in all intermetatarsal spaces bilaterally; second space did reproduce tingling in toes 2 and 3
Gait: increased navicular drop R>L coming into midstance which surprised me because she seems to have more reasons for this gait pattern on the left than the right
Other: Bilateral bunions with significant HAV
She said she has a history of an ankle fracture (she thinks left) as a child and bilateral plantar fasciitis which always resolves with rest.
She would like me to make orthotics to help her symptoms. She has already tried just a met pad on her regular inner soles with some relief but she isn't sure if the relief is due to the met pads or just altering her activities (less squatting and driving).
Any thoughts on the symptoms with squatting and why she is less symptomatic in Crocs? I thought the increased pronation allowed in the Crocs would allow more shear between the metatarsals and therefore more symptoms but in fact she is less symptomatic. The toe box looks sufficiently wide in the hiking shoe that compression should not be a problem.
Any thoughts?
Thank you!
Ann
Loading...
- Similar Threads - Puzzling symptoms gardener
-
- Replies:
- 0
- Views:
- 1,396
-
- Replies:
- 5
- Views:
- 12,531
-
- Replies:
- 7
- Views:
- 930
-
- Replies:
- 2
- Views:
- 929
-
- Replies:
- 0
- Views:
- 646
-
- Replies:
- 0
- Views:
- 850
-
- Replies:
- 2
- Views:
- 1,765