Help with patient

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Hi everyone, had a patient come limping in today with bilateral foot pain. He had arrived from Australia 2 days ago and was out seeing the sites yesterday in London for 8 hours when b/f started to hurt. He went home took ibuprofen and went to bed. Woke up this morning still in pain and was struggling to put foot to floor.

So he limps into the office removes his shoes and has inflamed area approximately 5cm diameter on dorsal aspect both feet in the area of the cuboid slightly tender to palpate approx no real swelling, 2/10 vas, tested all peroneals against resistance and palpated insertions of brevis and tertias 2/10 pain with good power 5/5 resisted with no real pain. Inverted foot as a stretch again 2/10 pain. Palpated and mobilised cuboid again 2/10 pain. EDB muscle palpated no real pain and resistance tested again 2/10 pain. As soon as this guy stood up pain scale 8-9/10? Foot posture wise nothing to note rectus foot good arch profile no nav drop or med deviation stj. Raising up on tiptoes showed some discomfort but when up on toes no pain.

No sign of bites etc

I'm working on cuboid syndrome as diagnosis at present so have issued him some temp insoles advised on rice and anti-inflammatory meds and will get him back in 3 days?

Any other offers/ help advice or extra things to test would be very welcome!!

Thanks all

Barty

 

Sorry bit more info guy was mid 20's approx 80 kg 's with no underlying medical problems, has had history of R inversion sprains as he plays basketball regularly.

Thanks

Bartypb

 

Stress fracture?

 

Since it's bilateral... shoe fit or construction? ( no shank, edge of welt irritation, inadequate last shape at cuboid).

 

What did X-rays show?

Post-static dyskinesia would suggest soft tissue injury tendon pathology perhaps.

 

Did he wear his shoes much of the time while on the plane over from Oz?
..compression due to swelling ..then a full days walking on top of that..?