When we started Podiatry Clinics (Yorkshire) Ltd 3 years ago we took over a couple of clinics from Andy Horwood who was moving up to Scotland to get married. I’m happy to say we have kept in contact with him and now have a joint paper published. It’s a case study on the treatment of Avascular Necrosis of the 2nd Metatarsal head, commonly known as Freiberg’s infarction.
Lee and Bob were approached by the parents of this patient as she had forefoot pain for 7 months that was not improving, despite being treated with insoles. We changed the type of insole she was using and gave her some simple foot exercises and her pain quickly improved. The case came up in conversation when Bob and Andy were lecturing together at Staffordshire University on their Masters course in Clinical Biomechanics. Andy asked if we had considered writing it up (we hadn’t – far too busy), offered to help and was the driving force for getting it into print.
This young girl had been through a lot. She developed an autoimmune liver complaint when 12 yrs old which needed large amounts of steroids to control. She later became very ill again as she developed Crohn’s disease that lead to her having a stoma fitted. She began to feel well again after the stoma and in her attempts to ‘get back to normal’ she re-started the dance classes she had missed so much. Unfortunately her right foot became painful at the same time. Orthopaedics diagnosed a ‘Freiberg’s infarction’ of the 2nd metatarsal head (which is often associated with high use of steroids) and the Hospital Orthotist made her an insole with a ‘U’ cut away under the 2nd MTPJ. This was in an attempt to reduce the loads going through the joint.
After 10 weeks, she wasn’t feeling much different and the 2nd toe had started to ‘claw’ so her parents, who Bob knew, asked us if we would take a look. From the way she was walking it was apparent that she was avoiding the joint as her heel raised from the ground.
We changed the insole for one that was raised just behind the MTPJ, to allow some controlled loading of the joint and gave her exercises that would help strengthen the muscles under her foot to help straighten the toe.
I phoned her parents weekly (to be on the safe side) and reviewed her in clinic after a month when her pain was 60% better and the 2 toe was no longer clawing. Another follow up 6 weeks after that and she was pain-free. I have recently contacted the patient who continues to be pain free. She has had her stoma reversed and life is looking up for her and most importantly, she’s dancing again – Result!
Link to the paper is here – Contact us if you can’t get hold of the full article….