Dear all
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I was wondering if you might be able to give some advice with the problem outlined below?
I have a customer who is a young boxer 17rs old (No1 junior in GB) who has very painful metatarsalgia both feet. He has very low plantarflexed but compliant 1st ray/mpj but this quickly becomes very stiff as the hallux is dorsiflexed because the plantar fascia is short and stiff and very prominent under a cavus compliant arch. The pain is sub 1st 2nd met heads but more diffuse than just sesamoiditis but is more painful on the 1st met head.
The problem is that everything is fine during normal walking and running it is only when boxing training that the pain becomes, as he describes, unbearable. In the dynamic boxing stance, only the very distal forefoot is on the ground (no heel or mid foot contact) and there is constant lateral and torsional shear as he moves back and forward and internally rotates the front foot to induce power thru the hip and shoulder to make an effective jab. The rearfoor internally rotates in a simmilar fashion to develop power for the cross.
He has had valgus forefoot extensions fitted to the soles of his boxing boots by the NHS, which did not reduce pain but increased time till pain. He had other various pads and orthoses made but these made no difference since they were typical manufacturing design (eg root) and he does not make use of any rear or midfoot accomodation or control since he never has contact with them in training and fighting.
I had thought of 6mm silicon with nylon backing ( as suggested by Robert Isaacs)as a simple insole to reduce shear forces, also Vasyli make a new insole called the Armstrong, which reduces shear forces by using a teflon sheet sandwiched between layers of shock attenuating material. (in conjunction with the modified boots)
Anything more accomodative or custom should not tend to dorsiflex the hallux more than is neccessary since this stiffens the 1st ray dorsiflexion signifcantly and early.
Do you have any ideas? have you come across this problem before?
I have a videos if you would like to view them but each one is about 40mb so might go over the download limit.
All the best Dave Smith
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