Written by: Cherri Choate, DPM
7/14/2010

        HPI:  Patient is a 68 year old male who presents to the clinic with pain on the top of his feet.  He worked as a longshoreman for more than 30 years, but does not remember a specific injury.  He has been retired for about 10 years and primarily spends his days gardening or volunteering at the local SPCA office.  He does walk 30 minutes a day and wears New Balance walking shoes most of the time.  The pain is achey and hurts primarily at the beginning and end of the day. 

PE:  Pain on palpation of 1st metatarsal cuneiform joint dorsally B/L.  Mild edema and erythema with exostosis palpable in same area.  No pain on ROM of MTJ or STJ.  Pain on ROM of 1st Ray B/L.

Radiographs- 1st metatarsal/cuneiform joint narrowing with exostosis dorsally B/L
Diagnosis:  1st metatarsal/cuneiform joint arthritis
Orthotic Goals:
     1) Stabilize midfoot
            Options-  semi-rigid or rigid plate
                            flat rearfoot post
                            deep heel cup
                            wide plate
     2) Increase surface area to equalize weightbearing area of foot
            Options-  wide plate
     3) Limit pronatory motion that would lead to dorsiflexion of 1st ray and motion at arthritic joint
            Options-  minimal fill
                            wide plate
                            deep heel cup
                            flat rearfoot post
                            Reverse Morton's Extension

     In many cases of foot arthritis determining the cause of pain, whether it is increaed motion or decreased motion, is important.  By stabilizing the foot and limiting the motion of the midfoot during stance phase of gait, the pain is likley to improve.

 

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