I’ve copied this directly from my training blog and I’m wondering what the PT types here think of this:
As I’ve been vocal about lately, I’ve been plagued with injuries this year, all in my left leg. One contribution to them is the wart on my foot. I think the other is my plantar fasciitis. Now, the plantar fascia are thick connective tissues that support the arch of the foot and run from the heel to the toes. I started having PF problems in December of last year and I thought I worked through them, but if I slacked off at them even for a week, my PF would come back. Now, let’s say that I didn’t really work through them that well. The pain has gone away, but the fascia are still tight given the quickness at the pain coming back when I didn’t do anything. What I’ve also noticed is that compared to me other foot and the other fascia in my left foot, the 3rd fascia is really tight. I work on it with a ball and stretch it and stuff, but it’s still tight. Let’s assume that it has been tight for so long that it has actually caused my metatarsal head to become misaligned and actually bring my 3rd metatarsal head down. With the 3rd metatarsal head in this position and not in the natural arch shape, it hits first when I take a step or run and caused the bruising that I started experiencing back in June.
Now, is this a plausable explanation or it just a pure coincidence that my 3rd fascia is really tight and my 3rd metatarsal head has fallen and become bruised?
Many do not actually believe in a “fallen metatarsal” or plantarflexed metatarsal without structural injury to the bone/joint itself (i.e. poorly healed fracture, stress fx, etc.) Usually associated with something else (retrograde hammertoe/tendon contracture pushing the met head down, etc.)
Big words don’t scare me, but please explain further what this retrograde hammertoe/tendon contracture is.
When I saw my PT initially for my injury, the 3rd met head was the clearly the lowest met when the 1st and 5th should be the lowest. My PT said my arch was fallen, but not that badly. Either way, the met head was bruised because it hit first and not the other mets. After putting in a met pad, new orthodics, and some time, the 3rd met head is no longer the lowest met and I have more of a proper arch.
A few years ago, I broke my pinky toe on my left foot. I’m doing some soft tissue stuff every day to loosen up the tissue between the 4th and 5th metatarsals because she thinks that might be contributing to the problem as well because now the lowest met is the 4th, not the 5th.
Sure - if a toe is contracted (usually at the PIPJ), it will push down at the MPJ (retrograde) making the metatarsal head appear/function “dropped” or plantarflexed. You can see this if you bend one of your fingers way back - notice the “bump” on the palm of your hand now. You just “dropped” your metatacarpal by contracting/extending a more distal joint. Same thing occurs in the foot, but to a much more severe extreme with weight bearing.
In fact, there is no correct “code” as far as insurance companies/Medicare is concerned with a “dropped metatarsal”. The code normally used is actually a trauma code as it relates to a plantarflexed metatarsal from dislocation (at the met-cuneiform or met-cuboid joint) or from a fracture. “Subluxed” tissues/bones/joint/etc. are poorly understood by most practitioners (except, perhaps Chiropractors), since they are poorly reproduced and difficult to “study” in the western scientific approach. That is not to say that they don’t occur and are perfectly treatable.