Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Recurring metatarsal pain, ongoing for 7 years

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Podstudent37, Sep 30, 2010.

  1. Podstudent37

    Podstudent37 Welcome New Poster

    Members do not see these Ads. Sign Up.
    Newly qualified, have seen a patient who had a crush injury to the third and fourth met heads approximately 7 years ago. She has recurring swelling, bruising and pain throughout the met area. I have advised footwear with sturdy soles, wide and deep toe box and laces/velcro to begin with as the pumps she is wearing are very flimsy and provide no support or protection. Why should this patient still be getting bruising after all this time and would a supportive orthotic help. :confused: Any advice would be really appreciated.
  2. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    Get x-rays and look at the metatarsal parabola and alignment. This is best appreciated on the medial oblique view. Look at the situation on a WB lateral and AP also.

    It is likely if there has been angular displacement or shortening, then there will be abnormal tissue stress through the affected and adjacent MTP joint structures.

    Correlate with clinical findings, and design an orthosis to offload the affected tissues.

  3. Dear Pod
    I run Foot Mobilisation courses and careful focussed mobilisation to the Metatarsals is the treatment of choice. I an teaching a course on the Metatarsals on 17th of October.
    The techniques I teach you will find very useful in your practice.
    If you send me your email address I will send you my newsletter with full details.
    Brian Joseph footmobilisation@gmail.com
  4. WApod

    WApod Member

    If there is unilateral swelling, temp difference between the feet + blotchy / bruised looking and ongoing pain+++ out of proportion to the original injury I would Investigate for complex regional pain syndrome (CRPS)... even to exclude it it is worth looking into.

    BTW The typical "profile" of a patient with CRPS is female, 35 - 55 has anxiety type issues or fibromyalgia type condition and is educated has an active job like a nurse or a teacher so if she fit's that definately look into it!
  5. Podstudent37

    Podstudent37 Welcome New Poster

    Thank you LuckyLisfranc, Brian Joseph and WApod for your help. My patient is an anxious 50 something, female and retired from an active profession. I am going to refer this lady for an MRI and will try offloading the area to see if this helps. Am I right in thinking that CRPS is a lifetime problem that can only be managed but not cured. Also I do believe that mobilisation may help as this lady has had something similar a few years ago which helped. :)

  6. I don't know where you got your information for the "typical profile" of a patient for CRPS, but to suggest these people have a typical psychological profile or have a typical type of education level or type of employment is, at best, comical.

    Most patients with complex regional pain syndrome (CRPS) that originate in the foot do have one thing in common, they tend to associate the beginning of their pain and CRPS with some type of traumatic event, with the most common being nerve trauma and ankle sprains. Just a couple of hours ago, I had lunch with Dr. Jeff Christensen, one of my former classmates from CCPM, and he is considered one of the leading authorities on foot CRPS. I would suggest you read Dr. Christensen's chapter in McGlamry's Textbook on Foot Surgery so you can become better educated on this very serious and difficult-to-treat disorder.

    Pretty cool also at this San Diego Seminar, for those of you podiatric surgeons out there, Dalton McGlamry himself, who I know pretty well, is here lecturing for Don and Richard Green at their 30th Annual Podiatry Institute Surgical Seminar. The Green brothers had a little celebration for Dr. McGlamry and his wife last night to commemorate his nearly 50 years of efforts to elevate the level of surgical knowledge for the podiatry profession both in our nation and internationally. Most of the authors from his books were there and many of his former surgical residents he has trained were in attendance to honor his amazing contributions for our profession. Dr. Dalton McGlamry is one of my podiatric heros. I was honored just to be there....one of the highlights of the meeting!!
  7. WApod

    WApod Member

  9. Ian Linane

    Ian Linane Well-Known Member

    I think that Brian has a point that there is value in mobilising the foot. Mobilisation can be joint oriented but it can also be soft tissue and in my experience people can respond well to a judicious application of both, post traumatic injury.

    My suspicion, if it is not CRPS and if MRI shows no other major concerns, is that there will need to be more soft tissue mobs than joint in this instance.

  10. Dear Ian
    Thank you for your positive comments regarding Metatarsal pain.
    It does seem logical to investigate the area for joints with compromised mobility and muscles with Myofascial Trigger Points.

Share This Page