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I am a student and have seen a patient who has a 6 month history of left lateral forefoot pain.
Symptoms increase with weightbearing and reduce with rest.
Pain is localised to forefoot and worse when wearing tight fitting/increased heel height shoes.
On ultrasound, a bursa measuring 9mm in diameter was found in the 3rd intermetatarsal space. I have suggested orthoses might be appropriate to manage the problem and believe a mid foot device is the best option (as it would redistribute pressure away from the forefoot).
Does any one have any references or articles I could read that would agree with my treatment plan? Also, does anyone have any extra information on how a mid foot orthotic is in fact, the best option?
You have already hinted at the other, a low heel pitch, broad toe box shoe and add for this client a mild rocker sole.
This would be a good move to reduce the weight-bearing effect on the area and the amount of extension during gait, which l would think would be quite painful also?
l cant see what country you are from, but if in Australia l would suggest the Ziera(Kumfs) Dazzle, a lace up off the shelf Derby that will take your orthosis(?) or from the same company on the same last and sole unit "Deidre3" a one bar mary jane, this sole unit is a mild rocker.
If your in the USA this brand Ziera (Kumfs) is also available, l am just not sure how wide spread its reach is yet
Dazzle is 3rd from the bottom of the page right hand side (see link) and Deirdre 3rd from the top left hand side.
Hi Alice have you considered an ultrasound guided injection of local and steriod. Being a student in OZ I know you can´t do it but refer out and go along for the appointment would be a good experience and most likey have the best result for your patients treatment plan.
Hi Alice have you considered an ultrasound guided injection of local and steriod. Being a student in OZ I know you can´t do it but refer out and go along for the appointment would be a good experience and most likey have the best result for your patients treatment plan.
The client has a history of the injury of only 6 months, would you not try all the non invasive treatment of orthosis and correct fitting shoes first, before going for the injection?
Lets face it, not everyone is keen to be injected(that would be me, l am allergic to pain) and even after the injection the client might still be best served to continue with the right orthosis and correct shoes to prevent the injury reoccurring.
The client has a history of the injury of only 6 months, would you not try all the non invasive treatment of orthosis and correct fitting shoes first, before going for the injection?
Lets face it, not everyone is keen to be injected(that would be me, l am allergic to pain) and even after the injection the client might still be best served to continue with the right orthosis and correct shoes to prevent the injury reoccurring.
Would you agree or am l wrong?
David,
I would in an Ideal world do both as you say get the shoes and device set up. Inject and have the conservative treatment work so i does not return.
Swollen Bursa in my opinion are one of those conditions that hang around - 6 months is a long time and are very easily inflammed again.
So treat with everything you have all at the same time for me. But to get fast and effective result, ie inject with steriod and local almost instant relief, and yes I agree shoes and device ready to go would be a great idea.
Orthotics for Bursitis
(that would be me, l am allergic to pain) and even after the injection the client might still be best served to continue with the right orthosis and correct shoes to prevent the injury reoccurring.
Hybrid Mode
