intermittant foot pain after birth of twins..

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Good morning ladies and gents.. Long term watcher 1st time poster

Need some advice regarding a pateint that I have seen in my clinic.

C/o

41 year old female with no prior history of foot,knee,hip or back pain developed an intermittant foot pain (both feet) exactly 4 weeks after giving birth to twins. It has now been over 11 months since the children were born and the issue has not subsided. The pain can come on at any time, it feels like her feet are being crushed in a vice. Pain confined to the dorsal aspect of the feet. Pain lasts for anything between 2-5 minutes and disappears almost instantly. Pain only occurs when she is sitting or lying down (but not appear each time she sits or lies down) pain is not specific to any way of sitting or lying and can occur whether she wears footwear or not. It usually happens 2/3 times daily.

Area of pain: Pain tracks up the edl tendons of the 3,4 & 5th toes both feet and stops at the ankle.


Previous Intervention.. Nothing done. Problem dismissed by Gp as hormones and what did she expect she had twins. Go and see Podiatrist for inserts. Physiotherapy advised nothing they could do.

General health: Very good
No history of any vascular or neurological problems.

Footwear today: Joma Speed running shoes.

Activity level: still on maternity leave:
usually very active but been restricted due to twins

Slump test: no pain

On examination: NWB As per usual i could not illicit a pain response today.. No lesion patterns either foot. No swelling. Good movement at 1st MTP, 1st ray, STJnt. Patient states that her feet are much more flexible since giving birth (advised this is expected)

on weight bearing Lowered arch height with foot over prontaed an extra 2 degrees , calcaneal eversion visible with bulge at talo/navicular and medial maleoli. Forefoot Supinatus, Supination resistance test moderate force, jacks test = early to moderate windlass with low force required to dorsiflex 1st toe. Lunge test shows no restriction. No pain iliicited from single leg raise and peroneus longus strength adequate.

No issues with limb length.

have requested further investigations regarding her back

Could the problem be related to the superficial peronel nerve/common peroneal nerve and be directly related to the pregnancy and the changing alignment of the hip and pelvis??




ross

 

Dear lexluthor
may i make a simple suggestion. see this woman when she has the pain and see if she has pain in the EDB or peroneal tertius.

Remember that looking at the back usually means radiation. The chances of it showing her problem if all methods of radiology is usEd is 16% on a good day.

when she presents with the pain try putting a 25 g needle into the tender spot. bet it is a trigger point. you did say that it comes on when lying down= foot flexion occurs and triggers the EDB abd peroneal tertius

let us know how you go

regards from an overcast south coast.
hoping for spring soon.
musmed
Paul conneely