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Have client with pain on palpation of space between 3rd and 4th metatarsal on her right foot. She came to me with x-rays which were inconclusive of this, but did show that there was Degeneration in the 1st MPJ.

I will treat this pain between in the 3-4 mets as mortons neuroma with orthoses and met dome. However........ This middle aged lady has short 1st metatarsals bilat with 2-3rd stage HAV. Should I prescribe the orthoses with a Morton's extensions? I haven't used them before, is this just an extension of the Polypropolene? Can it be added later?

Are Morton's extensions used much by Podiatrists? Any evidence to support their usage with short 1st met?

Also: Her 1st MPJ's were very mobile/hyperbobile.
Quite a lot of movement in MTJ with abducted foot in gait and mid foot pronation.

Thanks

 

Pigs:

You would get better therapeutic results in treating her Morton's neuroma with an orthosis with a metatarsal pad that is accompanied by your insistence that she also change to shoes that fit her foot properly and don't push laterally on her bunion bump during weightbearing activities. In other words, her short first metatarsal is not causing her neuroma pain but her tight shoes are....at least that would be my guess.

And what causes her tight shoes and, in turn, her neuroma pain??.....her bunions and western civilization's standard that women must have smaller, more pointy-toed shoes in order to appear fashionable.

On a similar note.....ever had a female patient insist that their shoes are not too tight only to find that when you examine them in their shoes that they are a full size too small and three widths too narrow??? It happens at least 3-4 times a week in my practice. Lesson to be learned??...never believe a patient that their shoes are not too tight until you have examined them yourself!