Our case study subject is a 29-year-old female working in childcare reporting bilateral foot pain, presenting as tired and aching feet worsening throughout the day, also with significant pain on weight bearing on the lateral border of the foot. As well as the painful symptoms, the subject is also experiencing early shoe wear and tear, having to replace her shoes every 6-12 weeks and as a result has gravitated towards cheaper more flimsy footwear as there seems to be no difference in wear between more expensive and cheaper models. Her foot symptoms are impacting her work and are limiting her ability to exercise and lose weight. She presents seeking a Pedorthic solution to her condition.
Static examination reveals bilateral severe metatarsus adductus foot position as classified under the Bleck’s classification, with heel bisection passing through the 5TH phalange. There is also a pes cavus foot position with associated forefoot valgus. Gait analysis reveals a mild intoed foot position with pes cavus and significant genu valgum and a high lateral loading of the foot. Plain film X-rays performed weight-bearing confirmed the metatarsus adductus and revealed what appears to be an unfused apophysis of the 5th metatarsal styloid process and it is here where her main foot pain occurs. Her shoes display significant lateral soling wear and the uppers have been badly deformed over the lateral border of the foot with the foot cantilevering over the soling unit and destroying the upper.
During the Pedorthic assessment the patient’s gait was analysed, static joint measurements taken and a weight bearing pedograph and 3D scan of the foot captured. The patient was advised on sturdy neutral footwear and provided information on makes and models to purchase via written referral to local footwear retailer. Once purchased, the shoe was modified via a “re-lasting” procedure to reflect her metatarsus adductus foot shape more accurately. A custom orthotics was then produced to suit the modified shoe environment, with prescriptive elements to offload the painful styloid process, match her pes cavus and forefoot valgus and control her hyper inversion.
After an 8-week period the shoes and orthotics were reviewed, and it was reported that her pain levels had reduced significantly, to the point that only one foot had mild symptoms. The patient was able to get though work shifts relatively pain free and shoe wear after 8 weeks uses was minimal. A greater amount of deflection was applied to the still painful foot, and it was reported that the pressure in the area was now completely removed. Through applying Pedorthic footwear modifications to existing shoes, costs to the patient were kept to a minimum and the reduced wear in the footwear mean that further cost savings can be achieved over the long term.