Can Orthoses Have An Impact For Bunions, Hammertoes And Morton’s Neuromas?

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Guest Clinical Editor: James Clough, DPM, FACFAS

   “Very often, you also need to spend a few moments with your patients to get them to start to roll through the first MPJ and take a longer stride and walk faster without shuffling,” suggests Dr. Clough.

   Dr. Horsley has found orthoses to be very effective for Morton’s neuroma. As he notes, when one designs orthotics with an accommodation to pocket the neuroma, it will dorsiflex the metatarsal heads directly adjacent to the neuroma. This will indirectly relieve the force from the deep transverse metatarsal ligament, according to Dr. Horsley. He notes the importance of accurately placing the accommodation for the neuroma.

   However, Dr. Horsley notes varying degrees of neural involvement that will respond to appropriate conservative therapies. Low Dye strapping can provide improved function of the first ray and when there is an accompanying neuroma pad, he says this combination provides evidence that the orthoses will offer a similar level of pain relief along with improved function.

   Are the symptoms directly related to the malfunction or instability of the first ray in combination with an equinus deformity? Is this condition referred pain from a tarsal tunnel syndrome? Dr. Horsley suggests a thorough physical evaluation and appropriate testing can assist in differentiation. If Morton’s neuroma is the final diagnosis, in this instance, he suggests control of the first ray, accommodation for the neuroma and intervention for the equinus with stretching and appropriate heel lifts.

   Dr. Clough is in private practice in Great Falls, Mt. He is a Fellow of the American College of Foot and Ankle Surgeons, and a Diplomate of the American Board of Podiatric Surgery. He is the inventor of the Cluffy Wedge (P4 Wedge) and the President of the Cluffy Institute.

   Dr. Horsley is an Assistant Professor and the Department Chair of Podiatric Surgery and Applied Biomechanics at the Dr. William M. Scholl College of Podiatric Medicine at the Rosalind Franklin University of Medicine and Science in Chicago. He is a Fellow of the American College of Foot and Ankle Surgeons.

   Dr. Richie is an Adjunct Associate Professor in the Department of Applied Biomechanics at the California School of Podiatric Medicine at Samuel Merritt University. He is a Past President of the American Academy of Podiatric Sports Medicine, and a Fellow of the American College of Foot and Ankle Surgeons. Dr. Richie is in private practice in Seal Beach, Calif. He also writes a monthly blog for Podiatry Today at www.podiatrytoday.com/blogs/doug-richie-jr-dpm/feed .

   Dr. Williams is in private practice in Merrillville, Ind. He is a Diplomate of the American Board of Podiatric Surgery. Dr. Williams is also a Past President and Fellow of the American Academy of Podiatric Sports Medicine.

   For further reading, see “Inside Insights On Common Orthotic Dilemmas” in the April 2010 issue of Podiatry Today, “Current And Emerging Insights On Hammertoe Correction” in the February 2012 issue or “Keys To Prescribing Orthotics For Sports, Neuromas And High Heels” in the October 2012 issue.

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