11/7/2022 0 Comments 1st mtp joint pain![]() ![]() Those wearing orthoses had a global perception of greater improvement in secondary outcomes including functional status, pain and stiffness, and physical activity levels, although statistical measurements of these domains were similar in both groups.ĭifferences in adherence between the groups may have influenced outcomes people in the orthoses group wore their inserts for an average of 448 hours compared with a much lower 287 hours of wear among the footwear group. ResultsĪfter 12 weeks of use, both groups showed indications of improved foot health, as measured by increases in the Foot Health Status Questionnaire (FHSQ) pain domain score of 17 points in the orthoses group and 22 points in the rocker footwear group. 3,4 The second group received a personally fitted pair of rocker-sole shoes designed with a rounded heel and soft cushioned sole to roll the foot forward. Those who showed a pronation score of at least 7 points on the Foot Posture Index (FPI) also received a beveled wedge that was customized to improve the score by at least 2 points. The chosen orthotics supplied were customized to each patient, using full-length inserts modified with cutouts below the first MTP joint. All participants received an informational handout on the care and use of their intervention. A total of 102 participants aged 22 to 78 years were randomly assigned to receive either foot orthoses (n=52) or rocker footwear (n=50). “Our research suggests that footwear and orthoses may help alleviate pain by altering the distribution of load under the foot while walking,” reported lead author Hylton Menz, PhD. ![]() 2 Previous evaluation of treatments for osteoarthritis of the first MTP joint-including surgical interventions, physical therapy, anti-inflammatory medications, orthoses, and footwear-has been limited and the findings largely inconclusive. The investigators reported that foot orthoses were perceived by users to offer greater improvement in pain compared with “rocker” footwear.Īn estimated 35% of people older than age of 35 show radiographic signs of osteoarthritis of the first MTP joint, 1 and nearly 8% of people older than age 50 exhibit progressive symptoms of joint pain and stiffness, bone deformity, and impaired range of motion. She is much better in sneakers than shoes.Patient preference and footwear choices may play a role in the success of treatments for osteoarthritis (OA) of the first metatarsophalangeal (MTP) joint, according to a recent Australian study by conducted Menz and colleagues, published in Arthritis Care and Research. She has a clean joint with lots of available motion that hurts with plantarflexion as well as dorsiflexion when irritated. She has about 90 degrees of passive dorsiflexion at the 1st MTP joint. Mechanically she has a large forefoot valgus in STJN and ambulates with a relatively "supinated" foot through the stance phase of gait (inadequate pronation coming into midstance). As I recall she may have had a mild grade 2 (at most) hallux valgus (using the Manchester scale). Her x-ray was read as normal although clinically she appears to have some minor hypertrophic bone on the dorsolateral surface of her 1st MTP. She generally wears an open dress casual shoe (like a Merry-Jane without the strap) but wore sneakers recently for 13 hours and had very little pain afterwards. ![]() Her pain occurs with plantarflexion and dorsiflexion of the joint to the point that she has a hard time using her foot to step on the gas pedal after work because plantarflexion of the hallux is so painful. ER physician who complains of severe pain at her 1st MTP joint at the end of the work day. He diagnosed pes cavus and hallux valgus. I'm looking for some thoughts about a patient I saw recently who was referred to me by our DPM for orthotics. ![]()
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