Keys To Identifying And Treating Vamp Disease

John Mozena, DPM, and Paul Clint Jones, DPM

   We offered the patient conservative care but he requested surgical intervention after the failure of orthotics, anti-inflammatories and shoe therapy including loosening his laces. We performed a midfoot exostectomy with no complications reported postoperatively.

Case Study Two: When A Runner Notices Growing “Bumps” On Her Foot And Sharp Pain With Ambulation

The patient was a 32-year-old female who had been running for nine months. She noted “bumps” on the top of her foot that seemed to be growing with time. The patient also reported numbness and pain that could radiate up to a level of 8/10 on the visual analogue scale with ambulation and running. She described the pain as a sharp sensation with tingling that radiated into the toes.

   Vascular and neurological exams were normal with the exception of deep peroneal nerve pain on palpation. The musculoskeletal exam was normal with the exception of a dorsal midfoot exostosis at the first and second metatarsocuneiform joint areas. Dermatological examination showed erythema at the second metatarsocuneiform area superficial to the exostosis itself. The biomechanical exam revealed increased pronation with posterior tibial dysfunction and an os tibiale externum. X-rays showed a decreased calcaneal inclination angle, an anteriorly broken cyma line and a bilateral midfoot exostosis. The patient was also wearing a shoe that was too narrow for her foot.

   Conservative care included injection therapy, a donut pad, taping, anti-inflammatories, shoe therapy (including re-lacing and an appropriate width shoe), home physical therapy and orthotic devices. Following the failure of conservative care, the patient had surgical intervention including a midfoot exostectomy and a Kidner procedure. The patient healed uneventfully.

Pertinent Insights On Deep Peroneal Nerve Entrapment

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