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60 year old male. Long Hx of a very painful right 1st MPTJ (puncture trauma 30 odd years ago bushwalking in thongs). Enlarged joint with nil d/flexion. X-Ray investigation reveals significant erosion of the joint cartilage and space narrowing. Dorsal lipping. Passive d/flexion elicits noteable pain. Compensates with an apropulsive, up and down gait gait. Tends to load up laterally. Knee and lower back problems devoped over time. Mortons extension to current custom device not working (unable to cope with load - Pt weighs 100 kgs). Apart from a rocker bottom sole and Sx any suggestions? Met bar to elevate 1st?

Steel or fibre forefoot plate to eliminate dorsiflexion.
He really does need a rocker sole... or surgery.

Definitely a rocker sole, coupled with periosteal acupuncture for symptom relief from 1st MTPJ.

IF you pt needs to be convinced re; the rocker sole, get them to purchase a pair of stiff soled walking boots with a forefoot rocker inc. You might find this alone your Rx of this individual.

Let us know how you get on.

Agreed.

To get a patient to trial a rocker sole so the result 'sells' itself to the patient I use the following:

1. Take a high density eva wedge about 10/12mm in depth and about shoe size wide.
2. Place under shoe.
3. Keep in place using a lot of rubber bands around the wedge and shoe.
4. Get the patient to go for a 5 min walk.

The advantage here is that the patient understands immediately what is happening and you can adjust the angle of the fulcrum easily to achieve the optimum and then you are not guessing when you are instructing your shoe technician on your prescription.

Understanding and compliance = Result

Not a high tech scanner in sight :)

Thanks for the advice one and all. The Eva wedge attached via rubber bands is a great idea. Will let you know how it goes. Again - thanks.

Chris

Fuse It.

This is osteoarthritis. It gets worse, not better. At best you can slow the process a smidgen. Do the patient a favour and refer to your local podiatric surgeon for a 1st MTPj fusion.

Sorry - could someone explain what a Morton's Extension is and what is it used for?

Thanks

Paul E Dunne

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Have you tried an intraarticular injection(2 cc lidocaine 2% pl plus 0.5 cc dexamethasone phosphate) for at least symptomatic relief?How about physical therapy?A morton's extension is ok here as well.If all else fails,either do a 1st mt head procedure or refer to someone who will do so.

Will a Morton's extension out of felt, give any comfort for painful Hallux R......or is a stiffer material needed?

I think that felt would help.I'd put 1/4 inch felt Morton's extension there as I do not think that 1/8 inch will be good.