Osteo-arthritis

In early summer 2015, I was still being troubled by my Plantar fasciitis. Not only that but my now sedentary lifestyle, with walking confined to the shortest of limped journeys , had seen me demonstrate an alarming weight gain. I returned to my doctor for further discussion. He had already sent me for an x-ray, this had revealed osteo arthritis in the first metatarso phalangeal joint. Laurence offered to immediately refer me to a specialist. Demonstrating a beautiful turn of phrase, very British in its manner, I feel, the doctor’s referral letter is worth showing below:

Dear Colleague,

Thank you for seeing this nice 54 year old gentleman who is an avid walker and has several goals that he hopes to achieve in the near future.

Unfortunately he has developed plantar fasciitis, which is affecting his walking a great deal, so he is keen to see a specialist for assistance in terms of insoles/support and also expertise in management of controlling his pain.

He is also keen to explore the possibility of being cured of the plantar fasciitis. He declines to have any topical or oral analgesics or anti-inflammatories.

A copy of his x-ray is enclosed.

Thank you for seeing him.

Yours sincerely,

 

Within a couple of days, the letter written, I went on the search for a suitable podiatrist. I was fortunate that speaking to the right people soon pointed me at Paul, a specialist podiatrist practising locally. After a short phone call, he agreed to see me a few days later. I sat in his office and poured out my woes. His notes reveal his findings:

Attended my practice complaining of pain in his left foot, around the heel and up into the arch. He is a very keen walker and since the onset of pain has been unable to do the level of exercise he wishes to, unfortunately this has led to weight gain which is more than likely exacerbating his foot pathology.

X rays have confirmed osteoarthritic changes in the first metatarso phalangeal joint.  This is clinically confirmed by the range of motion available in that joint being limited.

On resting calcaneal stance position his arches are good in height and his subtalar joint appears to be in a neutral state.  He does not show any lack in muscle power and all end feels are good apart from the 1st met head. 

Gait analysis shows a high degree of mid stance pronation with a relatively early heel lift for a man of his height.  There is some soft tissue ankle equinus, and he is obviously overloading the medial column of both feet but more so in his left, this again would tie in with the hallux limitus and degenerative changes.

We have talked at length regarding the treatment plan and realistic expectations. I have advised on a stretching regime for his gastrocnemius and soleus muscles and explained what I believe to be the aetiologies of the pain to be ie plantar fasciitis/ fibromatosis due to over pull on the band.

We will be reviewing him and designing him a custom pair of polypropylene orthotics to support the foot and reduce ground reaction forces on the plantar band, in an attempt to make his feet work more optimally.  After this is done I am hopeful his symptoms will cease and he can return to his beloved walking.

Basically, Three Points of the Compass is knackered, but not beyond hope. Not quite at the stage where I need to be taken outside and shot.

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