CONTACTS
SUBJECTS
Feet Pain Hiking Diagnosis Metatarsalgia Balls of Feet Orthotics Adj
0803 -
0803 - ..
0804 - Summary/Objective
0805 -
080501 - Follow up ref SDS 5 0000.
080502 -
080503 - Pain to balls of feet during hikes the past months. Had to pause
080504 - training a few days ago until a solution is developed. ref SDS 0 KI5G
080505 - Seems not caused by plantar fasciitis nor bone spurs, since symptoms
080506 - of those maladies are painful heels, ref SDS 0 IT9H, rather than balls
080507 - of the feet. Research indicates may have suffered metatarsalgia,
080508 - ref SDS 0 RQ6G, which requires rest, and in some cases orthotocis,
080509 - which can be developed with podeatry medical care through orothotics.
080510 - ref SDS 0 Q73I
080511 -
080512 - [On 140628 1215 meeting with Good Feet experiment wearing
080513 - orthotic design insoles indicates this can effectively
080514 - supplement mid-sole cushioning to protect balls of feet
080515 - against painful injury. ref SDS 6 S544
080517 - ..
080518 - [On 140711 1018 returned to Good Feet; the store was unable
080519 - to equal the fit and support for the Maintainer orthodic
080520 - inserts that was achieved originally on 140628; but since
080521 - there is no other evident solution, bought an ill-fitting
080522 - Maintainer insert to experiement on finding a solutiion.
080523 - ref SDS 10 MF6J
080525 - ..
080526 - [On 140713 hiking very painful - failed wearing Adidas
080527 - Response Cushion shoes resoled with increased cushioning
080528 - and complimented with orthodic inserts from Good Feet,
080529 - shown in case study on 120101 0900. ref SDS 1 XT7K Good
080530 - Feet refused to correct failed orthodics, reported in
080531 - meeting on 140713 1510. ref SDS 11 C56O, and the VA has not
080532 - had time to provide medical Podiatry guidance to resolve
080533 - metatarsalgia, noted in the letter to the VA on 140710.
080535 - ..
080536 - [On 140713 1640 bought Hoka Conquest shoes with boxed toe,
080537 - and midsole that increases rebound energy, and provides 50%
080538 - more cushioning to prevent pain from metatarsalgia on 11
080539 - mile daily hikes. ref SDS 12 8U8H
080541 - ..
080542 - [On 140726 1030 got Hoka Stinson Trail size 9.5 shoes
080543 - exchanged for Hoka Conquest and concerned about narrow toe
080544 - line that might contribute to metatarsalgia. ref SDS 13
080545 - VS3I
080546 -
080547 -
080548 -
080550 - ..
0806 -
0807 -
0808 - Progress
0810 - ..
081001 - Pain on balls of feet has prevented hiking for several days, reported
081002 - in a letter to Resole America yesterday on 140626 0752. ref SDS 5 EF6L
081004 - ..
081005 - On the last hike 3 days ago on 140624, had to stop at 10 miles, before
081006 - doing the last mile, due to excessive pain, reported in case study on
081007 - 120101 0900. ref SDS 1 EV8O
081009 - ..
081010 - Pain reported today continued over the next week, primarily on the
081011 - left foot and located at the 2 middle toes in the center of the ball
081012 - of the foot. This location was not evident today, but emerged
081013 - gradually over the next 7 days, such that some discomfort occurs
081014 - merely from walking around the house. Previously, pain in either foot
081015 - only occurred when hiking, and typically the last 2 miles or so of 11
081016 - mile daily hikes.
081018 - ..
081019 - Case study shows continual build up of metatarsalgia the past year,
081020 - causing stopping hiking entirely on 140625, reported on 120101.
081021 - ref SDS 1 PS3F
081022 -
081034 - ..
081035 - Research indicates foot pain reported in the record does not align
081036 - with symptoms for...
081037 -
081038 - Plantar Fasciitis and Bone Spurs
081040 - ..
081041 - Symptoms are presented on the Internet...
081042 -
081043 - 1. AAOS
081044 - American Academy of Orthopedic Surgeons
081045 -
081046 - http://orthoinfo.aaos.org/topic.cfm?topic=a00149
081048 - ..
081049 - 2. Plantar fasciitis (fashee-EYE-tiss) is the most common cause
081050 - of pain on the bottom of the heel. Approximately 2 million
081051 - patients are treated for this condition every year.
081053 - ..
081054 - Since the current symptom occurs in the ball of the feet, rather than
081055 - the heel, this does not align with symptoms of plantar fasciitis.
081057 - ..
081058 - AAOS article on Plantar fasciitis continues...
081059 -
081060 - 3. Plantar fasciitis occurs when the strong band of tissue that
081061 - supports the arch of your foot becomes irritated and inflamed.
081063 - ..
081064 - 4. The plantar fascia is designed to absorb the high stresses and
081065 - strains we place on our feet. But, sometimes, too much
081066 - pressure damages or tears the tissues. The body's natural
081067 - response to injury is inflammation, which results in the heel
081068 - pain and stiffness of plantar fasciitis.
081070 - ..
081071 - 5. Risk Factors
081072 -
081073 - In most cases, plantar fasciitis develops without a specific,
081074 - identifiable reason. There are, however, many factors that can
081075 - make you more prone to the condition:
081076 -
081077 - 1. Tighter calf muscles that make it difficult to flex your foot
081078 - 2. and bring your toes up toward your shin
081079 - 3. Obesity
081080 - 4. Very high arch
081081 - 5. Repetitive impact activity (running/sports)
081082 - 6. New or increased activity
081084 - ..
081085 - Heel Spurs
081087 - ..
081088 - Although many people with plantar fasciitis have heel spurs,
081089 - spurs are not the cause of plantar fasciitis pain. One out of
081090 - 10 people has heel spurs, but only 1 out of 20 people (5%) with
081091 - heel spurs has foot pain. Because the spur is not the cause of
081092 - plantar fasciitis, the pain can be treated without removing the
081093 - spur.
081094 -
081096 - ..
081097 - Metasarsalgia Pain Balls of Feet Shoes Fit Incorrectly
081098 -
081099 - Feet painful on forward section (commonly called "balls") of the feet
081100 - present symptoms diagnosed as "metatarsalgia."
081102 - ..
081103 - Research on the Internet explains the problem...
081104 -
081105 - 1. NHS [...England's National Health Service...]
081106 -
081107 - Metatarsalgia
081108 -
081109 - http://www.nhs.uk/conditions/metatarsalgia/Pages/Introduction.aspx
081111 - ..
081112 - Date last updated........................ 140514
081113 -
081114 - 1. Metatarsalgia is a term for pain that occurs in the front
081115 - section of the foot.
081116 -
081117 - [On 140708 1014 John at Resole America recommends
081118 - considering Hoka One One shoes to resolve metatarsalgia
081119 - from extended exercise training. ref SDS 9 XN5F
081121 - ..
081122 - 2. The pain can range from mild to severe and often gets worse
081123 - when you stand or do certain activities.
081125 - ..
081126 - 3. It is sometimes described as a burning or aching sensation.
081127 - You may also have shooting pains, tingling or numbness in
081128 - your toes. Some people also experience a sensation that
081129 - feels like walking on pebbles.
081131 - ..
081132 - 4. The pain often occurs in the area where the second, third
081133 - and fourth toes meet the ball of the foot.
081135 - ..
081136 - 5. Most cases of metatarsalgia can be treated using self-care
081137 - techniques such as:
081138 -
081139 - 1. Rice
081140 -
081141 - 1. Rest
081142 - 2. Ice
081143 - 3. Compression with bandage
081144 - 4. Elevate feet above heart
081146 - ..
081147 - 2. Painkillers such as paracetamol and non-steroidal
081148 - anti-inflammatory drugs (NSAIDs), such as ibuprofen, to
081149 - relieve pain
081151 - ..
081152 - 3. Change footwear or avoiding activities that are making
081153 - your symptoms worse
081155 - ..
081156 - 4. Shock-absorbing insoles, which can be fitted inside
081157 - your shoes to help cushion the pressure when walking -
081158 - these are available from pharmacies as well as sports
081159 - shops (runners often use insoles to protect their feet)
081161 - ..
081162 - [On 140628 1215 meeting with Good Feet experiment wearing
081163 - orthotic design insoles indicates this can effectively
081164 - supplement mid-sole cushioning to protect balls of feet
081165 - against painful injury. ref SDS 6 S544
081167 - ..
081168 - [On 140629 1921 follow up letter on 140520, ordering
081169 - coronary CTA with calcium score, ref SDS 4 VQ48, to assess
081170 - reducing level of care hiking 11 miles per day in order to
081171 - reduce side effects, ref SDS 7 UZ64; further request
081172 - referral to Podiatry for consultation to relieve
081173 - metatarsalgia side effects of prescribed care. ref SDS 7
081174 - U14H
081176 - ..
081177 - [On 140711 1018 returned to Good Feet; the store was unable
081178 - to equal the good fit and support for the Maintainer
081179 - orthodic inserts that was achieved originally on 140628;
081180 - but since there is no other evident solution, bought an
081181 - ill-fitting Maintainer insert to experiement on finding a
081182 - solutiion. ref SDS 10 MF6J
081184 - ..
081185 - [On 140713 hiking very painful - failed wearing Adidas
081186 - Response Cushion shoes resoled with increased cushioning
081187 - and complimented with orthodic inserts from Good Feet,
081188 - shown in case study on 120101 0900. ref SDS 1 XT7K Good
081189 - Feet refused to correct failed orthodics, reported in
081190 - meeting on 140713 1510. ref SDS 11 C56O, and the VA has not
081191 - had time to provide medical Podiatry guidance to resolve
081192 - metatarsalgia, noted in the letter to the VA on 140710.
081194 - ..
081195 - [On 140713 1640 bought Hoka Conquest shoes with boxed toe,
081196 - and midsole that increases rebound energy, and provides 50%
081197 - more cushioning to prevent pain from metatarsalgia on 11
081198 - mile daily hikes. ref SDS 12 8U8H
081200 - ..
081201 - [On 140726 1030 got Hoka Stinson Trail size 9.5 shoes
081202 - exchanged for Hoka Conquest and concerned about narrow toe
081203 - line that might contribute to metatarsalgia. ref SDS 13
081204 - VS3I
081205 -
081206 -
081208 - ..
081209 - Another sourece says...
081210 -
081211 - 2. American College of Foot & Ankle Orthopedics & Medicine
081212 - Metatarsalgia (Pain in the ball of the foot)
081213 -
081214 - http://www.acfaom.org/information-for-patients/common-conditions/metatarsalgia
081216 - ..
081217 - 1. Metatarsalgia develops when something changes or threatens
081218 - the normal mechanics (working action) of the foot.
081219 - Ultimately, this creates excessive pressure in the ball of
081220 - the foot, and that leads to metatarsalgia. Some of the
081221 - causes of metatarsalgia include:
081223 - ..
081224 - 2. Wearing shoes that do not fit properly: Shoes with a
081225 - narrow, tight toe box, or shoes that cause a great
081226 - deal of pressure to be put on the ball of the foot
081227 - (high heels, for example) are often the cause of
081228 - metatarsalgia. Because such footwear inhibits the
081229 - walking process and forces the wearer to alter his or
081230 - her step to adjust to the shoe, the mechanics of the
081231 - foot are compromised.
081232 -
081234 - ..
081235 - Case Study Stretching Adidas Response Cushion Size 9
081236 -
081238 - ..
081239 - Receive 3-pair Adidas Response Cushion shoes from Ebay;
081240 - they are slightly too small................................ 140402 1742, ref SDS 2 CZ5I
081242 - ..
081243 - Hiking 11 miles feet hurt wearing new Adidas Response
081244 - Cushion shoes, reported in case study
081245 - on 120101 0900............................................. 140202 1230, ref SDS 1 Z75O
081246 -
081248 - ..
081249 - Adidas Response Cushion shoes took 1 of the 3-pair shoes to
081250 - Dean's Shoe Repair for stretching.......................... 140403 1053, ref SDS 3 QW4N
081251 -
081252 - [On 140713 1640 bought Hoka Conquest shoes with boxed toe,
081253 - and midsole that increases rebound energy, and provides 50%
081254 - more cushioning to prevent pain from metatarsalgia on 11
081255 - mile daily hikes. ref SDS 12 8U8H
081257 - ..
081258 - [On 140726 1030 got Hoka Stinson Trail size 9.5 shoes
081259 - exchanged for Hoka Conquest and concerned about narrow
081260 - toe line that might contribute to metatarsalgia.
081261 - ref SDS 13 VS3I
081263 - ..
081264 - Another sourece says...
081265 -
081266 - 3. CNN.COM - Health Library
081267 -
081268 - Diseases and Conditions
081269 - Metatarsalgia
081270 - From MayoClinic.com
081271 - Special to CNN.com
081272 - Introduction
081273 -
081274 - http://www-cgi.cnn.com/HEALTH/library/DS/00496.html
081276 - ..
081277 - Date................................... January 24, 2005
081278 -
081279 - 1. ...What's more, running and even walking cause the same
081280 - burning pain on the bottoms of your feet. If this sounds
081281 - familiar, you may have metatarsalgia ? a condition marked
081282 - by pain and inflammation in the ball of your foot.
081284 - ..
081285 - 2. In each foot you have five metatarsal bones that run from
081286 - your arch to your toe joints. The first metatarsal is
081287 - shorter and thicker than the other four bones, which are
081288 - usually similar in size. During the push-off phase when
081289 - you walk, jump or run, your body weight is transferred to
081290 - your toes and metatarsals. The first and second metatarsal
081291 - bones take the brunt of this force, which can be as much as
081292 - 275 percent of your body weight.
081294 - ..
081295 - 3. Most metatarsal problems develop when the impact load or
081296 - the mechanics of your foot affect the way your weight is
081297 - distributed. This can put excess pressure on the
081298 - metatarsals, leading to inflammation and pain, especially
081299 - in the metatarsal heads ? the rounded ends of the bones
081300 - that connect with your toe bones.
081302 - ..
081303 - 4. Intense training or activity. Runners have the highest
081304 - incidence of metatarsalgia, primarily because the front of
081305 - the foot absorbs more force when running than during any
081306 - other activity ? as much as 110 tons of force per mile.
081307 - But anyone who participates in a high-impact sport is at
081308 - risk. Training intensely or for long periods puts even
081309 - more stress on the metatarsals, often leading to chronic
081310 - irritation and inflammation.
081312 - ..
081313 - 5. Wearing shoes that... that are too tight can compress your
081314 - toes, affecting foot mechanics. Wearing athletic shoes
081315 - that aren't well padded ? can put you at risk of
081316 - metatarsalgia.
081318 - ..
081319 - 6. Avascular necrosis (Freiberg's disease), a condition that
081320 - usually affects the second metatarsal head, occurs when a
081321 - temporary or permanent loss of blood to the feet causes
081322 - the death of bone tissue. Without treatment, the bone
081323 - itself may collapse. Although metatarsalgia alone doesn't
081324 - cause avascular necrosis, it may help trigger the
081325 - condition in people who have a predisposition to develop
081326 - it.
081328 - ..
081329 - 7. To recover from metatarsalgia, you need to keep stress off
081330 - the injured area, but you also need to remain active so
081331 - that you don't get out of shape.
081333 - ..
081334 - How long should "rest" occur?
081336 - ..
081337 - CNN.com article on Metatarsalgia continues...
081338 -
081339 - 8. Orthotic devices. These fit inside your shoes and help
081340 - minimize stress and improve foot function. They're usually
081341 - prescribed by your doctor and can be custom-made from a
081342 - plaster cast of your foot. You can also use off-the-shelf
081343 - orthotics, which come in various shoe sizes and can be
081344 - fitted immediately, although they usually wear out more
081345 - quickly than molded ones do. Orthotics are categorized as
081346 - rigid, semirigid and soft. As the name suggests, rigid
081347 - orthotics are constructed of a firm material such as
081348 - plastic or carbon fiber. They're designed to control
081349 - motion in two major foot joints below your ankles.
081351 - ..
081352 - 9. Semirigid orthotics are made of softer materials such as
081353 - leather and cork reinforced by silicone.
081355 - ..
081356 - 10. Orthotics designed to treat metatarsalgia may also have a
081357 - metatarsal pad placed in your shoes just ahead of the
081358 - metatarsal bone. These help deflect stress away from the
081359 - painful area. You can also use metatarsal pads on their
081360 - own, without an orthotic.
081362 - ..
081363 - 11. Shock-absorbing insoles. These are cushioned inserts that
081364 - fit inside your shoes to help cushion shock. Insoles are
081365 - often made of cork, plastic, rubber or a gel-like
081366 - substance called viscoelastic that's found in brands such
081367 - as Sorbothane, Airplus and Spenco. You can buy insoles in
081368 - drugstores and athletic shoe stores. Your doctor may
081369 - suggest trying inexpensive insoles or foot pads before
081370 - turning to orthotics.
081372 - ..
081373 - The author does not expressly explain "soft" orthotics, cited in the
081374 - initial paragraph. ref SDS 0 555L Are "Shock-absorbing insoles" the
081375 - intended explanation for "soft orthotics."
081376 -
081377 - [On 140713 1640 bought Hoka Conquest shoes with boxed toe,
081378 - and midsole that increases rebound energy, and provides 50%
081379 - more cushioning to prevent pain from metatarsalgia on 11
081380 - mile daily hikes. ref SDS 12 8U8H
081382 - ..
081383 - [On 140726 1030 got Hoka Stinson Trail size 9.5 shoes
081384 - exchanged for Hoka Conquest and concerned about narrow
081385 - toe line that might contribute to metatarsalgia.
081386 - ref SDS 13 VS3I
081388 - ..
081389 - 12. Don't train through the pain. For most athletes, taking
081390 - time off is more excruciating than the most grueling
081391 - workout. But continuing to play or train when you're
081392 - injured usually leads to more severe problems and longer
081393 - layoffs later on. And when you're recovering from an
081394 - injury, don't try to resume strenuous activity too soon.
081395 - If you're not completely healed, you're likely to re-injure
081396 - yourself.
081398 - ..
081399 - How long should "rest" occur - would be helpful to get an estimated
081400 - duration.
081401 -
081403 - ..
081404 - Another sourece says...
081405 -
081406 - 4. The Sports Injury Doctor
081407 -
081408 - Metatarsalgia - Forefoot pain
081409 -
081410 - 1. Here's what to do to prevent and treat a condition that
081411 - afflicts many athletes: metatarsalgia.
081412 -
081413 -
081414 - http://www.sportsinjurybulletin.com/archive/metatarsalgia.html#
081416 - ..
081417 - 2. Athletes in a variety of sports have noticed that when they
081418 - increase their total training load or engage in an unusually
081419 - long workout or competition, their feet are likely to pay the
081420 - price. More specifically, they often begin to experience some
081421 - discomfort on the bottom of one of their feet (or on the
081422 - bottoms of both feet) - toward the front of the foot, near the
081423 - toes. Such forefoot pain is known as metatarsalgia, which
081424 - simply means pain caused by inflammation at the ball of the
081425 - foot or at the juncture of the big toe or other toes with the
081426 - rest of the foot.
081428 - ..
081429 - 3. An athlete suffering from forefoot pain will frequently feel
081430 - very localised discomfort - as though there is a discrete
081431 - foreign object in his/her shoe. 'It feels like I have a stone
081432 - in my shoe,' is a frequent complaint. In some instances,
081433 - though, the pain is a little more diffuse and is described as a
081434 - burning or aching sensation. Occasionally, pain is felt
081435 - throughout the sole of the foot.
081437 - ..
081438 - 4. As mentioned, athletic activities which place stress on the
081439 - feet are linked with the onset of metatarsalgia. An unusually
081440 - long run or race, an extended basketball practice, a prolonged
081441 - soccer workout, a full day on the cricket field, can all induce
081442 - forefoot pain, as can sudden and significant increases in an
081443 - athlete's overall training load. Poorly designed or worn-out
081444 - shoes are probably a factor, too. Metatarsalgia experts
081445 - indicate that high arches, deformities of the toes, stiff
081446 - ankles, irritated nerves in the forefeet, bunions, poor
081447 - circulation to the feet (due to diabetes), gout, arthritis,
081448 - weight gain, and shoes with too-high heels are also
081449 - predisposing factors.
081451 - ..
081452 - 5. How to spot it
081453 -
081454 - You can be fairly confident that you have metatarsalgia if one
081455 - or more of your toe joints (ie, one or more of the joints
081456 - between the toes and the main body of the foot) becomes
081457 - inflamed, painful, and stiff. Swelling may be present, and if
081458 - you have metatarsalgia you will often experience a burning
081459 - sensation in the joint area. Generally, the swelling and pain
081460 - become progressively worse with continued activity, especially
081461 - if your shoes are fairly old or you have relatively poor foot
081462 - and ankle strength. In full-blown metatarsalgia, the pain can
081463 - be so intense that putting weight on the foot becomes nearly
081464 - impossible.
081466 - ..
081467 - 6. If you go to your healthcare professional for a diagnosis and
081468 - treatment, he/she should take a detailed personal and family
081469 - medical history. You'll be asked if you have recently gained
081470 - weight and whether closely related family members have had
081471 - either diabetes or gout. Diabetes causes poor blood
081472 - circulation to the feet, which can lead to pain similar to the
081473 - discomfort of metatarsalgia; gout produces profound joint
081474 - irritations which can mimic metatarsalgia, too. If there is
081475 - indeed a family history of either of those conditions, urine
081476 - and blood samples will often be taken to see if you are gout-
081477 - and diabetes-free. An x-ray - and even an MRI - may be
081478 - requested in order to inspect the troubled joint closely,
081479 - especially if your doctor suspects you might have a stress
081480 - fracture. In some extremely difficult-to-diagnose cases, tests
081481 - of nerve function in the foot may be necessary. Your doctor
081482 - will also want to know about the duration of your symptoms and
081483 - should ask you whether the pain is related to a single event.
081484 - He/she will want to know what activities provoke discomfort,
081485 - the exact location of your pain, and whether you have recently
081486 - changed your workout schedule, your athletic shoes, or the
081487 - surface upon which you train.
081489 - ..
081490 - 7. Start with box-toed shoes
081491 -
081492 - Once the factors that seem to cause the symptoms are
081493 - identified, your specialist will suggest changes in your
081494 - approach to training. If it appears that footwear is related
081495 - to your metatarsalgia (for example, your running-shoe midsoles
081496 - might have 'blown a tyre' and lost their resiliency after
081497 - months of training), getting new shoes is an obvious solution.
081498 - Therapists who treat metatarsalgia report that shoes with
081499 - 'boxy' toes tend to work better for forefoot-pain patients,
081500 - compared to shoes with narrow, more pointed toes. Box-toed
081501 - shoes seem to relieve the overall pressure on the forefoot and
081502 - permit the toes to spread apart during walking, jogging, or
081503 - running. This spread-out allows the toes to move in directions
081504 - other than the ones that produce pain.
081506 - ..
081507 - [On 140713 1640 bought Hoka Conquest shoes with boxed toe,
081508 - and midsole that increases rebound energy, and provides 50%
081509 - more cushioning to prevent pain from metatarsalgia on 11
081510 - mile daily hikes. ref SDS 12 8U8H
081512 - ..
081513 - [On 140726 1030 got Hoka Stinson Trail size 9.5 shoes
081514 - exchanged for Hoka Conquest and concerned about narrow
081515 - toe line that might contribute to metatarsalgia.
081516 - ref SDS 13 VS3I
081518 - ..
081519 - 8. Naturally, it may be necessary to limit your training until
081520 - your symptoms go away. Workouts may be made less lengthy and
081521 - intense (in severe cases of metatarsalgia, training will have
081522 - to cease until symptoms subside), and ice and elevation should
081523 - be used after training sessions are over. The best policy
081524 - appears to be to rub the painful area with ice for about 12
081525 - minutes at a time (while the foot is elevated), taking
081526 - 20-minute 'recoveries' between icings. Weight loss may be
081527 - helpful to the overweight athlete suffering from forefoot pain,
081528 - and non-steroidal anti-inflammatory medications are often taken
081529 - to provide pain control. There are a variety of different
081530 - orthotics which are used to treat
081532 - ..
081533 - 9. No carefully controlled, published scientific study has linked
081534 - orthotics with metatarsalgia relief.'
081536 - ..
081537 - 10. metatarsalgia, and - anecdotally - such products are said to be
081538 - helpful. Note, though, that no carefully controlled, published
081539 - scientific study has linked orthotics with metatarsalgia
081540 - relief. Orthotics are usually custom-made to fit the anatomy
081541 - of a patient's foot and are inserted into the athletic shoes.
081542 - The main feature of an orthotic made to relieve forefoot pain
081543 - is a supportive pad that fits under the joints of the toes with
081544 - the foot.
081546 - ..
081547 - 11. How long will you have to reduce or stop your training once
081548 - metatarsalgia arises? In uncomplicated cases caused by bad
081549 - shoes or training errors, appropriate treatment can usually
081550 - alleviate major symptoms in 10 to 14 days. Appropriate
081551 - treatment includes using newer and more supportive shoes,
081552 - icing, the use of anti-inflammatory drugs, a reduction in
081553 - training intensity and volume, the temperate employment of
081554 - exercises which strengthen the feet and improve range of motion
081555 - at the toe joints, and perhaps the wearing of a temporary
081556 - orthotic.
081558 - ..
081559 - 12. Don't train through it!
081560 -
081561 - If a stress fracture is discovered, symptoms may hang around
081562 - for four to eight weeks, and if obesity, diabetes, gout, or
081563 - arthritis are present it is very difficult to predict how long
081564 - the pain will last. Although athletes will be sorely tempted to
081565 - "train through" metatarsalgia, they need to realise that
081566 - activity will increase the stresses on the point of injury and
081567 - slow down the recovery process. Return to normal training and
081568 - competition should be delayed until underlying causes of
081569 - forefoot pain have been resolved and until major symptoms have
081570 - disappeared.
081572 - ..
081573 - 13. Here are our best tips for preventing metatarsalgia from
081574 - occurring:
081575 -
081576 - 1. Wear athletic shoes which fit properly and which are
081577 - appropriate to the activity. Don't go out for a 10k run
081578 - while wearing a pair of tennis shoes, for example.
081580 - ..
081581 - 2. Make sure that the insoles and midsoles of your athletic
081582 - shoes have not broken down, and that they do retain a
081583 - healthy measure of support. If your athletic shoes come
081584 - with paper-thin insoles, don't hesitate to spend an extra
081585 - 10 to 15 quid for more supportive structures.
081587 - ..
081588 - 3. With regard to midsoles, it is generally believed that
081589 - using midsoles for more than about 300 total miles of
081590 - movement leads to a situation in which the midsoles have
081591 - lost their 'compression-set resistance', which is just a
081592 - fancy way of saying they have lost their resiliency and are
081593 - no longer able to spring back to their normal configuration
081594 - after the foot makes impact with the ground. This loss of
081595 - resiliency may put extra pressure on the foot and
081596 - metatarsal joints.
081598 - ..
081599 - 4. Increase the intensity and duration of your training very
081600 - slowly and cautiously. Whenever more-than-just-niggling
081601 - forefoot pain appears, take a day off and then train
081602 - lightly for a few days to keep inflammation at bay. As you
081603 - resume normal training, use the stretches and exercises
081604 - below to ward off future problems.
081606 - ..
081607 - 5. If you are prone to metatarsalgia, use shoes with
081608 - relatively boxy toes, and try to avoid shoes which seem to
081609 - have increased heel height. The latter can pitch your feet
081610 - forward, putting extra pressure on your metatarsal joints.
081611 -
081612 - [On 140713 1640 bought Hoka Conquest shoes with
081613 - boxed toe, and midsole that increases rebound
081614 - energy, and provides 50% more cushioning to prevent
081615 - pain from metatarsalgia on 11 mile daily hikes.
081616 - ref SDS 12 8U8H
081618 - ..
081619 - [On 140726 1030 got Hoka Stinson Trail size 9.5
081620 - shoes exchanged for Hoka Conquest and concerned
081621 - about narrow toe line that might contribute to
081622 - metatarsalgia. ref SDS 13 VS3I
081624 - ..
081625 - 14. Follow these recovery exercises
081626 -
081627 - How do you recover from metatarsalgia once you've got it?
081628 - It is generally believed that increasing the range of
081629 - motion of the ankle, maintaining elasticity of the
081630 - Achilles tendon, strengthening the muscles and connective
081631 - tissues of the foot, and enhancing the flexibility of the
081632 - metatarsal joints help to spur recovery and reduce the
081633 - possibility of recurrence. Below we have listed four
081634 - 'classic exercises' which attempt to accomplish some of
081635 - these goals, and we have added two additional exercises
081636 - which will go a long way toward strengthening your feet in
081637 - a functional way and reducing your risk of metatarsalgia.
081639 - ..
081640 - 15. Classic Exercise No 1 - The Achilles-Tendon Stretch
081641 -
081642 - Stand with the toes and balls of your feet on a kerb or
081643 - step. Then, drop your heels down as far as possible,
081644 - without causing significant pain, of course. Rest in this
081645 - position for a few seconds, and then rise up on your toes,
081646 - holding this position for a few seconds as well. Carry out
081647 - three sets of 12 reps of this exercise per day, with 15-30
081648 - seconds of rest between sets. Over time, make the exercise
081649 - progressively more difficult by wearing a weighted vest
081650 - with increasing amounts of weight or by holding dumbbells
081651 - in your hands.
081653 - ..
081654 - 16. Classic Exercise No 2 - Ankle Flexion
081655 -
081656 - Simply sit on an elevated flat surface with the leg
081657 - associated with the affected foot crossed over the opposite
081658 - thigh. Grab the affected leg at the ankle with the hand of
081659 - the opposite side, and grasp the toes of the affected foot
081660 - with the same-side hand. Gently pull the toes of the
081661 - injured foot inward towards the lower leg, until you begin
081662 - to experience pain. Back off slightly to lessen discomfort,
081663 - and hold this position for five to 10 seconds. Relax for 10
081664 - seconds before repeating, and perform this sequence for
081665 - three sets of eight reps.
081667 - ..
081668 - 17. Classic Exercise No 3 - Ankle Extension
081669 -
081670 - Sit on an elevated flat surface with the leg of the
081671 - affected foot crossed over the opposite thigh. Grasp the
081672 - affected-side leg at the ankle with the same-side hand, and
081673 - grasp the toes of the affected foot with the opposite-side
081674 - hand. Then, gently pull toes and sole of the affected-side
081675 - foot toward the body to the point of significant pain.
081676 - Hold this position for five to 10 seconds, and then relax
081677 - for 10 seconds. Use three sets of eight reps per day.
081679 - ..
081680 - 18. Classic Exercise No 4 - The Ankle Turn-In
081681 -
081682 - Sit on an elevated flat surface with the leg of the
081683 - affected foot crossed over the opposite thigh. Hold the
081684 - affected leg at the ankle with the hand of the same side,
081685 - and grasp the toes of the affected foot with the
081686 - opposite-side hand. Cautiously bend the foot upward at the
081687 - ankle towards the inner leg to the point of significant
081688 - pain. Again, hold this position for five to 10 seconds,
081689 - with 10 seconds of relaxation following. Perform this
081690 - sequence 10 times, three times daily.
081692 - ..
081693 - 19. Although the above exercises should help improve the
081694 - flexibility of the ankles and feet, they are not very
081695 - functional, ie, they do not resemble movements that occur
081696 - in any known sporting activity (few athletes carry out
081697 - their activities in a seated position while holding one
081698 - foot). With the exception of exercise number one, there is
081699 - no weight-bearing involved, and there is little emphasis
081700 - on balance and coordination, little integration of various
081701 - muscle groups, and probably diminished 'carry-over' to
081702 - real-world sporting activity. The following two exercises
081703 - take care of those problems and do a great job of
081704 - improving foot and ankle strength and resiliency.
081706 - ..
081707 - 20. Functional Exercise No 1 - Toe Pulls
081708 -
081709 - To perform this exercise, stand barefoot with your feet
081710 - hip-width apart. In an alternating pattern, curl the toes
081711 - of your right foot and then your left foot down and under,
081712 - as though you were grasping something with the toes of each
081713 - foot. Try pulling yourself across the floor (smooth
081714 - surfaces work best) for a distance of three to six feet as
081715 - you become more skilled at this exercise. Start with 25
081716 - reps per foot, and work up to three sets of 75 reps per day
081717 - (a rep is one 'grasp' of one of your feet).
081719 - ..
081720 - 21. Functional Exercise No 2 - Downhill Hops
081721 -
081722 - Running or hopping downhill increases the ground-reaction
081723 - forces experienced by the foot and leg, compared with
081724 - running or hopping on level ground (or uphill). Forcing the
081725 - feet and ankles to respond to these higher forces has an
081726 - overall strengthening effect. Going downhill also increases
081727 - the stresses on the forefeet in particular, which is
081728 - strengthening in the long term but potentially
081729 - pain-producing in the short term, so be cautious with this
081730 - exercise. Start with a moderate downslope of about 3%, and
081731 - hop downhill on your right foot for about 20 metres or so,
081732 - staying relaxed at all times, looking ahead (not down at
081733 - your right foot), and achieving good springiness with your
081734 - right ankle. Jog back up, repeat with the left foot, and
081735 - your first set is complete. Rest for a moment if necessary,
081736 - and then carry out one or two more sets. As you get
081738 - ..
081739 - 22. 'If your athletic shoes come with paper thin insoles, don't
081740 - hesitate to spend an extra 10 to 15 quid for more
081741 - supportive structures.' stronger and more coordinated, you
081742 - can increase your speed of hopping, the length of the
081743 - downslope, and of course the percentage declination. Don't
081744 - try for long leaps as you go downhill; you are looking for
081745 - quick, efficient bounces that minimise energy cost. In
081746 - effect, you should 'pogo-stick' your way down the hill,
081747 - using the elastic energy of your ankles and legs as much as
081748 - possible, instead of working hard to hop forward.
081750 - ..
081751 - 23. Owen Anderson
081752 -
081753 -
081754 -
081756 - ..
081757 - Another sourece says...
081759 - ..
081760 - 5. San Diego Running Injuries
081761 -
081762 - Metatarsalgia
081763 -
081764 - http://www.sandiegorunninginjuries.com/metatarsalgia.html
081766 - ..
081767 - Metatarsalgia
081768 -
081769 - 1. What is it?
081770 -
081771 - Metatarsalgia results from a sprained metatarsal ligament
081772 - also know as the plantar plate. Direct repetitive impact
081773 - on the 2-4 metatarsals and toes during running and jumping
081774 - or standing for long periods in high-heeled shoes can cause
081775 - the ligaments beneath the second through fourth metatarsals
081776 - to sprain. This common condition is often misdiagnosed as
081777 - Morton?s Neuroma. If there is no burning pain shooting
081778 - into your toes but rather it feels like you have a rock in
081779 - your shoe then you are probably suffering from
081780 - Metatarsalgia.
081782 - ..
081783 - 2. How did I get it?
081784 -
081785 - It can result from flattening of the arches, poor shoe
081786 - choices, or possibly repetitive trauma to your foot as in
081787 - running or jumping.
081789 - ..
081790 - 3. How is it treated?
081791 -
081792 - For healing to occur the pressure must be taken off the
081793 - sprained metatarsal ligaments. Using a ten step process a
081794 - Metatarsal pad can be effectively placed on your insole
081795 - working as a support and relieving pressure on the
081796 - ligaments.
081798 - ..
081799 - 4. Rest: For many rest is not a realistic option, the race
081800 - you are training for is looming. Our body is a wonderful
081801 - ?machine?, if you rest it long enough it will heal itself.
081802 - How long? This is uncertain. Some sufferers report that
081803 - they rested weeks to years and even now can not walk
081804 - without pain. Some undergo painfully expensive surgery and
081805 - the pain still persists.
081807 - ..
081808 - 5. How long will it take to heal?
081809 -
081810 - This depends on how long you have been suffering from
081811 - Metatarsalgia. By correcting the cause of the injury with
081812 - San Diego Running Institute orthotics and following the
081813 - treatment regimen provided by Dr Runco you can often expect
081814 - immediate relief usually in your first office visit. Ask
081815 - your San Diego Running Institute expert about how to get
081816 - your Metatarsalgia fixed today.
081818 - ..
081819 - This aligns with experience visiting with Good Feet. Wearing the
081820 - orthotic "exercise" insole, there was no evident relief from pain
081821 - walking and running in the store. However, wearing something called
081822 - a "maintainer" insole, there was immediate relief due to evident
081823 - redistribution of stress from the ball of the foot to the length of
081824 - the foot.
081826 - ..
081827 - Additional research indicates that orthotics might help...
081829 - ..
081830 - 6. Podiatry Today
081832 - ..
081833 - A Guide To Orthotic Treatment For Metatarsalgia
081834 -
081835 -
081836 - Volume 25 - Issue 4 - April 2012 46910 reads 1 comments
081837 - Start Page: 74
081838 - 78
081839 - Author(s): Jamie Yakel, DPM
081840 -
081841 - http://www.podiatrytoday.com/guide-orthotic-treatment-metatarsalgia
081842 -
081843 - 1. Orthotics can be a vital part of treatment for the
081844 - sometimes vague diagnosis of metatarsalgia. Accordingly,
081845 - this author expounds on the benefits of orthotics and
081846 - accommodations such as metatarsal pads and bars for
081847 - metatarsalgia arising from conditions such as lesser
081848 - metatarsophalangeal joint instability.
081850 - ..
081851 - 2. On a daily basis, podiatrists see patients who complain of
081852 - pain in the forefoot. Some are self-diagnosing patients
081853 - who tell you they have metatarsalgia based on what they
081854 - saw on the Internet. Depending on what you read,
081855 - metatarsalgia is a symptom and not a diagnosis. What
081856 - really is metatarsalgia?
081858 - ..
081859 - 3. Metatarsalgia is a non-specific term for pain in the
081860 - forefoot. The generally accepted theory is that the pain
081861 - is occurring in or near the metatarsal heads, the
081862 - metatarsophalangeal joints (MPJs) or is caused by soft
081863 - tissue injury. It can be a challenging problem because of
081864 - the vagueness of the symptoms and the vast conditions it
081865 - could encompass. The word ?metatarsalgia? includes
081866 - conditions such as Morton?s neuroma, stress fractures,
081867 - predislocation syndrome/plantar plate tear, capsulitis,
081868 - plantarflexed metatarsals, Freiberg?s disease,
081869 - intermetatarsal bursitis, calluses secondary to hammertoes
081870 - or clawtoes, and rheumatoid arthritis.1
081872 - ..
081873 - 4. Scranton found 23 different diagnoses of metatarsalgia in
081874 - 98 patients.2 Forty-five patients had primary
081875 - metatarsalgia, 12 of whom had static disorders and 12 of
081876 - whom had iatrogenic (postoperative etiologies.
081877 - Thirty-three patients had secondary metatarsalgia, 11 of
081878 - whom had rheumatoid arthritis and 10 of whom had
081879 - sesamoiditis. Twenty patients experienced pain under the
081880 - forefoot.
081882 - ..
081883 - 5. Helal classified metatarsalgia as primary or secondary with
081884 - primary metatarsalgia being an anatomic abnormality
081885 - resulting in increased pressure under the metatarsal
081886 - heads.3 Examples include short or long metatarsals, hallux
081887 - valgus, rigidus and first ray hypermobility. Secondary
081888 - metatarsalgia is pain not originating within the metatarsal
081889 - area. Secondary causes include Morton?s neuroma,
081890 - rheumatoid arthritis, equinus deformities and Freiberg?s
081891 - infraction.
081893 - ..
081894 - 6. Regnauld classified metatarsalgia as diffuse, localized,
081895 - subcutaneous soft tissue and cutaneous.4 Scranton found
081896 - that primary and secondary metatarsalgia can occur
081897 - together.2 Nonetheless, one should determine the etiology
081898 - and implement a focused treatment plan. Having a
081899 - fundamental understanding of anatomy and biomechanics, and
081900 - emphasizing a thorough history and physical can aid in
081901 - identifying the diagnosis and creating that treatment plan.
081902 - The mainstay in treating metatarsalgia is non-operative
081903 - management.
081905 - ..
081906 - 7. Orthotics are key components in treating metatarsalgia and
081907 - one can employ various orthotic modifications after
081908 - identifying the underlying etiology. Manipulation, shoe
081909 - modifications, injections and surgery are other treatment
081910 - options clinicians can use with or instead of orthotics.
081912 - ..
081913 - 8. Loss of shock absorption due to distal migration of the fat
081914 - pad can expose the metatarsal heads to increased pain.
081915 - This is more pronounced in the cavus foot type with digital
081916 - contractures and increased declination of the metatarsal
081917 - heads. The goals with orthotic therapy in this case are to
081918 - decrease the shock and reduce the pressure on the
081919 - metatarsal heads. One can accomplish these objectives by
081920 - using a shock absorbing material such as Spenco, PPT or
081921 - another material.
081923 - ..
081924 - 9. Pressure mapping is one method of evaluating pressure on
081925 - the metatarsal head region and it can also be beneficial in
081926 - evaluating pre- and post-orthotic efficacy. In addition,
081927 - one can raise the metatarsal heads by using a metatarsal
081928 - bar. Alternately, the clinician can leave the anterior
081929 - edge of the orthotic full thickness as opposed to thinning
081930 - it out at the distal edge. This will help transfer weight
081931 - proximally and serves in a sense as an internal metatarsal
081932 - bar.
081934 - ..
081935 - 10. Closer Look At Conditions Related To Metatarsalgia
081936 -
081937 - Intractable plantar keratoses (see Key Insights On Intractable
081938 - Plantar Keratoses at
081939 -
081940 - http://www.podiatrytoday.com/key-insights-intractable-plantar-keratoses
081941 -
081942 - ...) and calluses are painful conditions that can respond
081943 - to orthotic modifications. Intractable plantar keratoses
081944 - can be a result of a plantarflexed metatarsal, whether they
081945 - are due to retrograde pressure of digital contractures or a
081946 - structural abnormality. Finding the happy medium in regard
081947 - to offloading the intractable plantar keratoses can be
081948 - difficult. Metatarsal pads, metatarsal bars, dancers pads
081949 - and padding are some of the modifications available.
081950 - Again, a metatarsal bar can also transfer the weight
081951 - proximally. A full-length topcover using Korex to
081952 - accommodate the lesion(s) works very well.
081954 - ..
081955 - 11. Another cause of metatarsalgia is early heel-off, which in
081956 - pressure.creases the pressure on the metatarsal heads and
081957 - subsequently causes a longer duration of weightbearing.
081958 - Evaluate for early heel-off, whether it is from a leg
081959 - length discrepancy or equinus. Carefully assess the ankle
081960 - joint for equinus. Dananbergs manipulation method is an
081961 - excellent adjunct one can perform to restore ankle joint
081962 - range of motion.5 In combination with orthotics, this is
081963 - an excellent way of reducing some of the metatarsal
081964 - pressure.
081966 - ..
081967 - 12. Mortons neuroma is one of the most common causes of metata
081968 - pressure.rsalgia. The diagnosis of Mortons neuroma is
081969 - clinical. The most common complaints are pain, numbness
081970 - and tingling in the involved digits. Often, patients
081971 - complain of a feeling of stepping on a stone or the
081972 - sensation of a wadded up sock. Conservative treatment
081973 - options consist of shoes with wide toe boxes; orthotics
081974 - with a metatarsal pad or bar; steroid injections;
081975 - non-steroidal anti-inflammatory (NSAID) medications; and
081976 - alcohol sclerosing injections.
081978 - ..
081979 - 13. Can Metatarsal Pads Be Effective?
081981 - ..
081982 - The addition of metatarsal pads is the mainstay in treating
081983 - Another cause of metatarsalgia is early heel-off, which
081984 - increases the pressure on the metatarsal heads and
081985 - subsequently causes a longer duration of weightbearing.
081986 - Evaluate for early heel-off, whether it is from a leg
081987 - length discrepancy or equinus. Carefully assess the ankle
081988 - joint for equinus. Dananbergs manipulation method is an
081989 - excellent adjunct one can perform to restore ankle joint
081990 - range of motion.5 In combination with orthotics, this is an
081991 - excellent way of reducing some of the metatarsal pressure.
081992 - neuromas with orthotics. The purpose of metatarsal pads is
081993 - to transfer the weight proximally to the metatarsal shafts
081994 - but, in the case of neuromas, the purpose is to separate
081995 - the metatarsal heads. Koenraadt and colleagues found the
081996 - use of metatarsal pads increased the width of the forefoot,
081997 - supporting the use of metatarsal pads in the treatment of
081998 - neuromas.6
081999 -
082000 - Metatarsal pads come in various sizes and shapes. It is uni
082001 - pressure.versally accepted that one should not place the
082002 - metatarsal pad under the metatarsal head but proximal to
082003 - the metatarsal heads. The width of the pad should support
082004 - the second, third and fourth metatarsal heads, and avoid
082005 - the first and fifth metatarsal heads. Be careful to avoid
082006 - extending the pad proximally to the tarsometatarsal
082007 - joints.
082008 -
082009 - The key component is where to place the metatarsal pad. Do you
082010 - place it at the leading edge of the orthotic plate or have it
082011 - extend distally to the plantar plate? Hsi and colleagues
082012 - concluded that one should place the pad proximal to the
082013 - metatarsal head and just distal to the distal edge of
082014 - the orthotic.7 Hayda and co-workers found that distally
082015 - placed, small, felt metatarsal pads reduced the most
082016 - pressure on metatarsal heads.8 The shape, material and
082017 - size of the metatarsal pad may have some effect on relief as well.
082019 - ..
082020 - 14. What You Should Know About Lesser MPJ Instability
082021 -
082022 - Lesser metatarsophalangeal (MPJ) joint instability is a
082023 - common cause of metatarsalgia, specifically affecting the
082024 - second MPJ. Predislocation syndrome, a term often used for
082025 - this instability, is an acute, chronic or inflammatory
082026 - condition that affects the MPJs, but the second MPJ is the
082027 - most affected.
082029 - ..
082030 - 15. While there are various intrinsic and extrinsic structures
082031 - that stabilize the joint, the plantar plate is the key
082032 - anatomical structure. The inflammatory process causes
082033 - attenuation of the structure, which leads to dislocation.
082034 - Factors such as hallux valgus, metatarsus primus elevatus,
082035 - an elongated second metatarsal and a hypermobile first ray
082036 - can cause an overload of the second MPJ leading to
082037 - instability.
082039 - ..
082040 - 16. Non-operative treatments include padding/strapping to
082041 - reduce any retrograde pressure on the joint, NSAIDs,
082042 - intra-articular steroid injections, orthotics and shoe
082043 - modifications. When injecting steroids into the joint,
082044 - rocker bottom shoe modifications are highly recommended to
082045 - eliminate the propulsive phase of gait and reduce the
082046 - possibility of further attenuation secondary to steroid
082047 - injection. After confirming the diagnosis and identifying
082048 - the etiology, one can implement the orthotic modification.
082050 - ..
082051 - 17. If the etiology is an elevated first metatarsal, there are
082052 - several options to address this and the goals should be to
082053 - increase the ground reaction forces under the first
082054 - metatarsal head and reduce lesser metatarsal overload.
082055 - There are various options to achieve these objectives.
082056 - These options include: a Mortons extension; a first ray
082057 - cutout with or without a reverse Mortons extension in the
082058 - second through fifth sub-metatarsals; a reverse Mortons
082059 - extension by itself; and a Cluffy wedge.
082061 - ..
082062 - 18. Controlling rearfoot pronation by increasing the subtalar
082063 - joint supination moment with a medial heel skive or Blake
082064 - inverted pour can help stabilize the first ray.
082065 - Plantarflexing the first ray while casting for orthotics is
082066 - an option but is controversial to some.
082068 - ..
082069 - 19. Case Study: Using Orthotics For A Runner With Forefoot Pain
082071 - ..
082072 - A 40-year-old male runner presented to the office with a
082073 - two-week onset of swelling and pain in his right forefoot.
082074 - He relates he had a second metatarsal stress fracture eight
082075 - months ago and another one about a year before that. The
082076 - patient was immobile in a surgical shoe for seven weeks
082077 - before resolution of his symptoms. He enjoys running half
082078 - marathons but his training has been reduced since then
082079 - because of the initial stress fracture. The patient had
082080 - participated in cross training via swimming and biking. He
082081 - denies any change in his mileage, training surface or
082082 - shoes. He also denies any acute episode of an injury.
082084 - ..
082085 - 20. Clinically, the patient had a pinch callus on the right
082086 - hallux but no other hyperkeratotic lesions. He had
082087 - exquisite tenderness over the second metatarsal with edema
082088 - around the second and third metatarsal region. Pain was
082089 - also present in the second intermetatarsal space but it was
082090 - not as pronounced as it was over the second metatarsal. A
082091 - mild to moderate dorsal bunion was present at the first
082092 - MPJ.
082094 - ..
082095 - 21. The patient had approximately 40 to 45 degrees of
082096 - dorsiflexion at the first MPJ on the right foot with no
082097 - pain or crepitus. However, he had approximately 5 degrees
082098 - of dorsiflexion with loading of the foot.His subtalar joint
082099 - range of motion was normal and he had gastroc-soleus
082100 - equinus. Gait evaluation demonstrated an abductory twist
082101 - with early heel-off on the right side. The sock liners of
082102 - his running shoes showed considerable wear under the right
082103 - hallux and the lesser metatarsal area. The area under the
082104 - first metatarsal showed very little wear.
082106 - ..
082107 - 22. Radiographs revealed a periosteal reaction along the neck
082108 - of the second metatarsal with no displacement. There was
082109 - metatarsus primus elevatus of the first metatarsal with no
082110 - spurring off the dorsal first MPJ and no joint space
082111 - narrowing. The metatarsal parabola was normal.
082113 - ..
082114 - 23. The treatment plan consisted of immobilization in a surgical shoe for six to
082115 - eight weeks, aggressive gastroc-soleus stretching and molding for orthotics.
082116 - His orthotic for the right foot consisted of a first ray cutout and a reverse
082117 - Mortons extension in an effort to increase the ground reaction forces to the
082118 - first metatarsal head.
082120 - ..
082121 - 24. He resumed his running two months after the resolution of his symptoms. At
082122 - his three-month orthotic check, I added an additional 1/8-inch of Korex to
082123 - the reverse Mortons extension. I have been able to follow him now for two
082124 - years and he has not had any recurrence of his stress-related symptoms.
082126 - ..
082127 - 25. In Conclusion
082129 - ..
082130 - Metatarsalgia is similar to lower extremity edema. They are
082131 - symptoms of other conditions but there is usually an
082132 - underlying cause.
082134 - ..
082135 - 26. This article is not all-inclusive but is more of a broad
082136 - overview and summary of some of the more common conditions
082137 - included in metatarsalgia. Custom foot orthotics are an
082138 - important component in treating metatarsalgia and
082139 - podiatrists should be well versed in these accommodations.
082141 - ..
082142 - 27. With the decreased emphasis on biomechanics in the podiatry
082143 - arena, if you are unsure of what accommodation to use and
082144 - when, do not be afraid to use your orthotic lab for
082145 - recommendations. Your patients will be rewarded.
082146 -
082147 - *********************************
082149 - ..
082150 - Dr Yakel is a Fellow of the American College of Foot and
082151 - Ankle Surgeons, and is board certified by the American
082152 - Board of Podiatric Surgery. He is an Associate of the
082153 - American Academy of Podiatric Sports Medicine. Dr. Yakel
082154 - practices in Longmont, Colo.
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