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:
- 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:
- Custom made orthotics fabricated from a 3D casting
https://www.pedorthic.ca/insurance-providers/casting/
- 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
