9/1/2011 10:48 AM
I had an interesting patient today who presented with complaint of pain on the plantar aspect of her foot only when she used the elliptical machine. When asked to point to the most painful area, she pointed under the plantar lateral aspect of the foot, particularly near the styloid process. She had been to two other podiatrists. The first recommended anti-inflammatory measures, and the second made her a pair of orthotics, but they actually made the problem worse.
This seemed to be a fairly straightforward problem in that she had a plantarly prominent styloid process on the right foot, which was the painful foot. This is the area where she was experiencing pain. Obviously, the pain was secondary to pressure on the prominent styloid.
Orthotic Evaluation: Her current orthotics were polypropylene with a rearfoot post. They were adequate width, but when the patient was held in neutral position the orthoses were gapping significantly from the arch of the foot. There was no accommodation for the styloid on the orthosis and the devices had an EVA top cover. In effect, the orthoses were simply putting a harder surface under the foot without effectively transferring pressure off the prominence.
I explained to the patient that our goal in this situation is to transfer pressure off of the styloid process and that should eliminate her pain. The following is the orthotic prescription I recommended:
ProLab clients are encouraged to contact one of our medical consultants if they have questions regarding any orthotic devices.
1 comments so far...
By Yvonne Delamater on
9/1/2011 7:56 PM
Re: Orthotics for Patient with Plantar Prominent Styloid Process
Is the styloid process the bony protuberance on the middle side of the outer foot, halfway between the little toe and the heel (hitherto now, I was calling it the fifth tuberosity because my understanding of foot anatomy is minimal)? If yes, I've had a strange problem with that area where it feels as though it sometimes "jumps" out of position, almost like the bone is coming "out of joint". I didn't have this problem with my old orthotics but it started when I got new orthotics and a Richie-type brace, both at the same time. I couldn't tolerate the Richie-type brace and no longer have it. I still have the orthotics and the bony protuberance at times feels like it will jump out of position though much less often than before.
It was interesting to read your article about how to accommodate this area. I subscribe to the RSS feed for your blog and find it helpful.
PS Do any doctors in northern NM (Albuquerque, Santa Fe, Los Alamos) use your lab to make orthotics? Your lab sounds like it has high standards of workmanship.