Dear Gwyneth
With the info you supply a diagnosis is difficult. Do you have HAV on the
r/foot with bunion or exostosis, you say there is no imflamation but the 2nd
MPJ is enlarged and soft tissue swelling occurs after waklking, and there is
some 3rd MPJ involvement with increased spacing. Is there pain on passive
plantarflexion of the 2nd? or is it more painful to dorsiflex?
Have you thought about Freibergs Infarction. Had a similar case a few weeks
ago, an ortho surgeon colleauge that I talked to advised that x ray can be
unreliable and MRI is better for diagnosis in some early cases.
If it is a plantar plate tear then you need to use strategies that reduce
2nd dorsiflexion moments, such as taping and padding until there is healing.
But it sounds as if Clive Chapman has it right already and you will have to
get used to wearing roomier shoes all the time or put up with the pain and
continue to cause trauma when using inapropriate shoes..Having said that the
7mm pad on top of the orthosis with 12dgs f/foot varus posting. No wonder
its tight.
I've never used more than 6dgs f/foot posting. Does anyone else commonly use
as much as 12dgs.
Cheers Dave Smith
----- Original Message -----
From: "Gwyneth Price" <[log in to unmask]>
To: <[log in to unmask]>
Sent: Thursday, February 17, 2005 9:46 PM
Subject: Neuroma ?
> Hello, I hope that you can help me. I am a podiatrist of thirty odd years
> and have some understanding of biomechanics. I have recently suffered
> problems with my own feet and before I visit the orthopaedic surgeon, to
> whom I have been referred, I would like to run it past you all.
>
> I am female , 55 years old , 5'4'' and weigh about 9st. I walk, with my
> dog, at least two miles a day , more at weekends. I have had orthotics for
> the last 20years. I used to get knee pain. I usually wear Hotter shoes or
> boots.
>
> Five years ago I had a neuroma removed from each foot from the 3rd-4th
> space. One I had had for twelve years and the other for twenty. The
> symptoms were classic and there was never any doubt in my mind what they
> were. The operations were successful and only faint tingly sensations are
> left.
>
> We now come to my current problem. My right knee had became painful again
> over a period of years and I realised that I probably need a new
> orthotic .However before it was prescribed I suddenly developed this acute
> pain around my second met head. After trying U pmp cover pads I consulted
> the doctor and he tested me for any rheumatic disease. This was negative.
> At this he told me to go home and put ice on it! However he did agree to
> send me for a scan.
>
> The doctor who did the ultrasound was very obliging and let me see all
> that was going on . However he had to admit that there didn't seem to be
> anything definite there but perhaps it was an A-typical neuroma. He agreed
> that it was not like my first experiences of neuromae.
>
> However,by this time there was some displacement of the third toe , so he
> sent me for an x-ray. Unfortunately I did not get to see the x-ray but my
> doctor inform's me that there was no indication of damage. My appointment
> with the surgeon is not until April. I did have one privately but I
> changed my mind as it was costly and did he know any thing I didn't ? My
> one concern is it that it might be sinister, but my doctor could not get
> the surgeon to give me an earlier appointment, so presumably, he is not
> concerned.
>
> So, I have my new orthotic which helped my knee a bit but as I wasn't
> walking well it is difficult to judge. It is from Pegasus, it is the
> standard type and has the first MPJ cut out. My right foot has intrinsic
> posting of 12degrees varus on the forefoot and 1 degree varus on the rear
> foot. My right leg is also shorter so there is a 4mm heel raise too.
>
> This orthotic did not help my foot pain but it did not make it worse
> either. We did try a poron extension from the met heads to the end of the
> toes but it just filled up the shoe and created more pain. On the advice
> of Clive Chapman I am now wearing a 7mm met bar from second to fifth and
> it is relatively comfortable. This is provided that I only wear capacious
> footwear to accommodate the orthotic and the pad. Without them, in heeled
> shoes, I am quickly in agony.
>
> The second MPJ does feel thickened to me compared with my left foot. The
> third toe curls out slightly, indicating spacing, but I cannot elicit a
> click , a shooting pain, nor palpate a swelling. My own doctor said there
> were no signs of inflammation but the is a discolouration of the skin,
> some swelling over the joint and it becomes hot when I have walked a lot.
> These to me do not indicate a neuroma.
>
> What do I do now? I am reluctant to have surgery unless it is absolutely
> necessary. But I am anxious that it might be malignant. We have various
> cancers in our family. Also I would appreciate some advice on what to do
> with my orthitic. I really would like to wear sandals some times.
>
> I hope that I haven't rambled too much. Thanks, Gwyneth Price
>
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