Causes and findings:
• Overuse or trauma - female ballet dancers who over-point or football players
• Pain on dorsum of foot - usually at third metatarsocuneiform joint line
• Painful and limited: adduction and inversion of midtarsal joints
Equipment:
Syringe - 2 ml
Needle - 23G 1 inches (25mm) blue
Kenalog 40 - 20 mg
Lidocaine - 1.5 ml 2%
Total volume - 2 ml
Anatomy:
There are several joints in the mid-tarsus, each with its own capsule. Gross passive testing followed by local joint gliding and palpation should identify the joint involved.
Technique:
• Patient lies with foot supported in neutral
• Identify and mark tender joint line
• Insert needle down into joint space
• Pepper some solution into capsule and remainder as bolus into joint cavity
Aftercare:
Avoidance of excessive weight-bearing activities for at least 1 week is advised. Mobilizing and strengthening exercises and retraining of causal activities follow. Orthotics and weight control, if necessary, are useful additions.
Comments:
This is a successful treatment provided sensible attention is paid to aftercare.
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