Dr Child's Casebook: Best Foot Forward

Our feet take us places, they are the platforms on which we navigate the word’s bumpy terrain. But in Marfan syndrome, feet lose their support, become lax and the arches can flatten. This culminates in metatarsalgia, inflammation of the ball of the foot, an important pressure point. Such a condition inhibits your life. Suffering acute metatarsalgia for some time and having exhausted all avenues of help, a Marfan sufferer turned to Dr Child for advice. As ever we are protecting the patient’s identity.

Q: I am a Marfan Man and experiencing real trouble with one of my feet (metatarsalgia) for c. 12 months which is very negatively affecting my day to day life and mental state. I have struggled to find NHS and / or private podiatrists / orthopaedic surgeons who have a specialism in patients with Marfan syndrome that I could speak to as the people I have dealt with seem to have hit a wall with the issue. Do you have a list of any Marfan specialists who I could discuss the issue with over the phone maybe? I’d be happy to speak to anyone, anywhere over Zoom.

A: This is a common problem in Marfan syndrome due to lax ligaments in the foot. This allows the foot to go flat, and arches are lost. There are two arches in the foot, one running the length, and the other one underneath the base of the toes. In Marfan syndrome, probably both arches are flat. This puts strain on the ligaments attaching all the small bones together. Until the arches are supported, the ligaments will continue to register pain. You could try buying an elastic figure 8-shaped ankle support from your chemist. This may help to support the arch.

I suggest you make an appointment with an orthotist, and one can usually be found on a high street, or by looking in your Yellow Pages or online. They will measure your foot, and please ask for arch supports to be made for both arches on an inner sole made of memory foam. This will be soft enough to wear all day inside your shoes. For this reason you need to buy shoes which are deep enough to take your foot and the inner sole, so take your inner soles with you when you shop, and try them in the new shoes before you buy. Sports shoes are especially kind to feet.

While you are waiting for your appointment, you could try a medication for arthritis. You are too young to actually have osteoarthritis in your feet, but the pain is the same. Try paracetamol, Anadin Extra, or if these don't work, ibuprofen (Brufen) 400mg morning and evening with food. If you take Brufen for longer than 1 week, and you find it works, please ask your doctor to prescribe Omeprazole 10mg each morning to protect your stomach from irritation.

I would recommend a lace-up shoe, so that the mid foot is supported. Keep your weight low to reduce strain on the feet. Look at your exercise habits and avoid sports which involve impact such as running.

If none of this helps, please ask your GP to refer you to an orthopaedic department where there is at least one surgeon who specialises in foot and ankle surgery. The Royal National Orthopaedic Hospital and Guy's Hospital have good reputations for treating Marfan syndrome patients. However, surgery should be the last option, since surgery can cause different kinds of pain, although the support might be restored.

I hope this is helpful. Please let us know how you get on.


Dr Child's Casebook: Best Foot Forward
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