Metatarsal Pain Email Followup

This nice patient presented one month ago with a 2 month history of very severe pain in her metatarsals (pain levels on 8-9 out of 10). There has to be something broken or nerve involvement to have that high pain level. New orthotic devices were given to her 2 weeks ago since she stands all day at work. We are trying to avoid a removable cast, which will make her job difficult. There is her 2 week email followup and my response.

Hi Dr. Blake. This is the 2 week report. I'm wearing my new orthotics all of the time now and am attempting to be optimistic. When the inflammation occurs after a short shift at work(4 hours), I recover nicely the next day. Yesterday, I had a 7 hour shift and today I'm pretty swollen and need to stay off of my feet. By tomorrow, I'll probably be much better. It seems like I have to be very strategic about how I spend time on my feet. There's a threshold for how much I can handle.
So, do you have any suggestions? Yes, I am alternating hot/cold . I'd love to hear your words of wisdom. Thanks.
 
Bobbie (not her real name), Thanks for the email.
 
     Sounds like you are doing every thing right. Definitely do the contrast bathing once a day and add an ice pack for 10 minutes twice per day.
 
     I could have the physical department experiment with various forms of taping for you to do, and they could do some treatments of anti-inflammatory stuff to cool things down.
 
     A Budin splint can be purchased at our sports shop to limit motion around the metatarsal joints, and I can try a different type of orthotic to control the foot motion possibly better. So, a lot to do. Come back in 2   weeks and we will advance your treatment, hopefully in the right direction. Rich
 
I had 3 types of orthotic devices to choose from initially and I chose the Root Balanced Technique to maximize the metatarsal support. I definitely may have to change it to get more stability.