Patient John Doe (55 yo male teacher with type 2 Diabetes) presents to his family doctor with bilateral painful 1st MPJ. The doctor diagnosed: bunions, halux valgus, and pes planus. The patient was referred to a Pedorthist for evaluation and treatment.

The Pedorthist conducts an extensive history and assessment including range of motion testing, gait analysis,footwear evaluation, and a diabetic risk assessment. The Pedorthist finds:

  • ROM/ Non Weight Bearing Evaluation
    • Bilateral bunions and hallux valgus
    • Hallux limitus bilateral
    • Redness on 1st MPJ bilateral
    • Normal ROM at all other major foot/ankle joints
  • Weight Bearing Evaluation
    • Flexible pes planus
    • Everted Calcaneus
    • Genu valgum
  • Gait analysis
    • Moderate overpronation in mid stance with failure to re-supinate at propulsion
    • Medial propulsion off 1st MPJ during toe off
    • Abducted Forefoot
  • Current Footwear Evaluation
    • Too narrow, with seams on the 1st MPJ placing pressure on the 1st MPJ
    • Flexible midfoot and forefoot allowing foot to easily overpronate as patient walks
  • Diabetic Risk Assessment
    • Patient tested with Inlows 60 second diabetic assessment tool:—Inlowe-Foot-Screen-Handout.pdf

  • Scored a 4, which indicates yearly screening
    • 1 point for improper footwear, 2 points for bunions, 1 point for halux limitus

The Pedorthist educates the patient on their findings and the importance of Footcare/Foothealth for someone with Diabetes.

The Pedorthist treats with:

  • High heel cup and medial border to reduce excessive pronation and mechanical force on the 1st MPJ
  • Diabetic friendly materials (antimicrobial and friction reducing materials)
  • Evenly distributing pressure to reduce plantar pressure
  • Mortons Extension bilateral to accommodate the halux limitus
  • Footwear education
    • Wide toe box with no seams so there are no external pressures on the foot
    • Rocker toe to reduce flexion at the 1st MPJ and subsequent pressure
    • Stiff mid foot for torsional stability
    • Adequate space for orthotic (removable insole)
  • Yearly screening
  • Referrals to other health professionals
    • Advised to see a footcare nurse or Chiropodist for routine treatment of nails and skina