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Sunday, January 30, 2022

Adding Stiffness to the front of a Shoe: Help for Many Problems in the Front of Our Feet


     My retired partner, Dr Jane Denton, known world wide of the Denton Modification for over supination, continuously used this metatarsal stiffener. It is a 1/16 to 1/8 inch thickness of out sole material. All chronic pain in the area may be helped with this shoe modification. When patients tell you that they feel better as the shoe stiffness increases, this may be something that a shoe cobbler can add to a more flexible shoe. It should be done on both sides (even if the pain is on one side). It can always be removed if not helpful, or after the need for stiffness passes. 

1/8 inch Stiff Out Sole Material Applied to Add Stiffness for Painful Metatarsals



The Stiffness has to be created with 1/16 to 1/8 inch Material only. This increases someone's falling odds due to separating the ground from the foot, so has to be broken in to gradually. The patients that it works for are really pleased that they can wear some normal looking shoes. 

3 comments:

  1. Hi Dr. Blake,
    I have been reading up on sesamoid fractures and stumbled upon your blog! I read your previous posts, but still have questions. In Sept. 2021, I had sudden onset of left foot pain that felt like I couldn't weight bear. It came and went fairly quickly, but I was left with top of foot pain. I tried conservative treatments (Tylenol, changed my shoes, heat/ice, rest), but the pain persisted. Every doctor told me how strange it was, but we explored possibilities. I have a genetic clotting condition and history of severe DVT, my first clot starting with left foot pain. So we first did an ultrasound to rule out new clots in November. In December, we did x-rays, which looked okay but the radiologist recommended a MRI. With the holidays, I was unable to have my MRI until January. Much to all of our surprise, the sesamoid was fractured.

    I am working with a Foot and Ankle Podiatric-Orthopedic Surgeon. He explained to me that the bone is fractured into several pieces, some of which are crushed, and he believes there is some Avascular Necrosis too. He is concerned also because it appears that some of the bone fragment is showing indentation into the metatarsal sesamoid sulcus area? I'm not 100% what that means still. At this point there is no known cause of injury, which is also frustrating. He put me into a walking boot because there are concerns about balancing the rest and total NWB with my clotting issues. We are using an orthotic that I was already using prior to the injury in the boot. I have been in the boot for just about 4 weeks. I see him again for a follow-up in about 2 weeks, where he felt we'd know a lot based on my pain level. I am still dealing with a lot of pain in and out of the boot. I have found I'm manipulating my foot so I'm walking on the outside edge again both in and out of the boot, which seems to help pain but I know long term it's not helping me. My doctor told me that if this doesn't work, we will be discussing surgery more seriously.

    1. Do you feel this is the right kind of dr to work with? My PCP wasn't sure if we should go podiatrist or ortho route. He specializes on the inner workings of the foot, so it seems to make sense to me. I have spoken with several people who have worked with him professionally and personally and they all have excellent things to say.

    2. At this stage in the game, should I be feeling relief? I know everyone is different, but after a month of less walking on it, a full time walking boot except showering and sleeping, and caution, shouldn't I be feeling some better?

    3. The other people you spoke with that I saw all wanted conservative treatment no matter how long it took them. I applaud them for that, but I am feeling increased stress about time. I work full time in Special Education, am a full time college student, and I run a local food pantry, not to mention everything else in life! I am worried about the surgical option, but this isn't working well either. Some people I read about have been dealing with this conservatively for years and years. I can't imagine dealing with this pain and lack of mobility that long. At what point does surgery feel like a necessity?

    Thank you in advance if you have time to answer these questions. I am feeling increasingly more stressed by this situation and just desperate for some pain relief to get back to moving with less pain.
    Hannah

    ReplyDelete
  2. Hi Dr. Blake,
    I have been reading up on sesamoid fractures and stumbled upon your blog! I read your previous posts, but still have questions. In Sept. 2021, I had sudden onset of left foot pain that felt like I couldn't weight bear. It came and went fairly quickly, but I was left with top of foot pain. I tried conservative treatments (Tylenol, changed my shoes, heat/ice, rest), but the pain persisted. Every doctor told me how strange it was, but we explored possibilities. I have a genetic clotting condition and history of severe DVT, my first clot starting with left foot pain. So we first did an ultrasound to rule out new clots in November. In December, we did x-rays, which looked okay but the radiologist recommended a MRI. With the holidays, I was unable to have my MRI until January. Much to all of our surprise, the sesamoid was fractured.

    I am working with a Foot and Ankle Podiatric-Orthopedic Surgeon. He explained to me that the bone is fractured into several pieces, some of which are crushed, and he believes there is some Avascular Necrosis too. He is concerned also because it appears that some of the bone fragment is showing indentation into the metatarsal sesamoid sulcus area? I'm not 100% what that means still. At this point there is no known cause of injury, which is also frustrating. He put me into a walking boot because there are concerns about balancing the rest and total NWB with my clotting issues. We are using an orthotic that I was already using prior to the injury in the boot. I have been in the boot for just about 4 weeks. I see him again for a follow-up in about 2 weeks, where he felt we'd know a lot based on my pain level. I am still dealing with a lot of pain in and out of the boot. I have found I'm manipulating my foot so I'm walking on the outside edge again both in and out of the boot, which seems to help pain but I know long term it's not helping me. My doctor told me that if this doesn't work, we will be discussing surgery more seriously.

    1. Do you feel this is the right kind of dr to work with? My PCP wasn't sure if we should go podiatrist or ortho route. He specializes on the inner workings of the foot, so it seems to make sense to me. I have spoken with several people who have worked with him professionally and personally and they all have excellent things to say.

    2. At this stage in the game, should I be feeling relief? I know everyone is different, but after a month of less walking on it, a full time walking boot except showering and sleeping, and caution, shouldn't I be feeling some better?

    3. The other people you spoke with that I saw all wanted conservative treatment no matter how long it took them. I applaud them for that, but I am feeling increased stress about time. I work full time in Special Education, am a full time college student, and I run a local food pantry, not to mention everything else in life! I am worried about the surgical option, but this isn't working well either. Some people I read about have been dealing with this conservatively for years and years. I can't imagine dealing with this pain and lack of mobility that long. At what point does surgery feel like a necessity?

    Thank you in advance if you have time to answer these questions. I am feeling increasingly more stressed by this situation and just desperate for some pain relief to get back to moving with less pain.
    Hannah

    ReplyDelete
  3. Very interesting! Will try this out!

    ReplyDelete

Thank you very much for leaving a comment. Due to my time restraints, some comments may not be answered.I will answer questions that I feel will help the community as a whole.. I can only answer medical questions in a general form. No specific answers can be given. Please consult a podiatrist, therapist, orthopedist, or sports medicine physician in your area for specific questions.