Self-analysis materials (e.g., photos, charts, study reports to interpret, questions to think about etc.)

In this part of the lesson, the participant will receive a case description for independent analysis. He will find out what problem the patient is struggling with, how the diagnosis and treatment were carried out, and the results obtained. Later, the participant will independently consider the decision to continue treatment. Additionally, a communication problem to be solved on your own will be described. 

1. Read the story of a young woman aged 30 complaining of pain in her feet and the first MTP joint. 
2. Analyze the following research results 
3. Think about what treatments you could offer this patient? 

Patient: Female, 30 years old, height 164 cm, weight 56 kg. The respondent works in an office. Due to her workplace, she usually wears elegant clothes and high heels. 

Diagnosis: hallux valgus 

Treatment: 4 years ago the patient underwent physical therapy 

Reason for visiting a physiotherapist: symmetrical pain in the first MTP joint of the first foot, stronger on the left side. Since the last visit to the physiotherapist, the patient reports additional pain in the knee joint. She has not had any injuries. 

Clinical examination (conducted 4 years ago)  

Podoscope test results: 

Left foot                                                                                 Right Foot 

Hallux valgus angle α – 20°                                                    Halux valgus angle α – 14° 

Wejsfolg Index – 2,30                                                            Wejsflog Index – 2,48 

Clark angle – 50°                                                                    Clark angle – 47° 

Heel angle (gamma) – 23°                                                       Heel angle (gamma) – 20° 

V toe varus angle V β – 9°                                                       V toe varus angle V β – 6° 

Physiotherapy treatment was used (laser therapy, ultrasound, low-frequency magnetic field and shock wave). Additionally, the physiotherapist recommended modifying the footwear worn (lower heel, wider forefoot). 

1. The above results represent the assessment of only the plantar part of the feet. Which of the tests you have learned could you include in the study? 
2. What other treatments could you suggest to the patient? 

ATTENTION! – if during the interview the patient reports other symptoms such as pain and morning stiffness, swelling of small joints, the presence of nodules, generalized fatigue, sensory disturbances, you will notice other deformations, e.g. hammertoes, low-grade fever of unknown origin, vascular changes and others. These symptoms may indicate the occurrence of a general inflammatory process. In such a situation, suggest a consultation with your family doctor or specialist for more accurate diagnosis. 

A sample rehabilitation program for a patient is presented below: 

Ad.1 

Due to the reported symptoms, it is worth repeating the podoscopic examination (to observe the progression of the defect). Additionally, it is worth assessing the position of the hindfoot (assessment for valgus), which often coexists with hallux valgus. If the pain is localized in the forefoot area, it is worth performing the Morton test. 

Ad. 2 

In addition to physical treatment aimed at treating pain and inflammation, it is worth including physical exercises and taping in the rehabilitation program. Their main purpose, as the literature indicates, is to relieve pain and improve mobility. Below are some examples of exercises that you can suggest to a person with hallux valgus: 

1. Rolling the golf ball under the foot, moving from the heel towards the toes and vice versa. Do this in several strands. 
2. Performing autotraction in the 1st metatarsophalangeal joint 
3. “Welcoming the Foot” 
4. Short foot exercise 
5. Toe spread out exercise 

Additionally, you can use hallux valgus taping: 

  – Application using the fascial technique (15-25%) in the Y shape. The base was glued on the big toe, the tails along the medial edge of the foot. 

– Then we use the fascial correction technique in form I. The base is glued to the medial-dorsal surface of the forefoot, and the tail is guided towards the outer dorsal surface of the foot. When applying the tape, the foot is in a flexed position 

– Additionally, if the toe was in rotation, an application correcting the position of the toe was performed before performing the procedure in point 1.  Due to the lowering of the transverse arch, it may be suggested to consult a specialist who produces insoles.