Longstanding peroneus longus tenosynovitis at the cuboid notch

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Dear podiatrists and colleagues,
I am seeking advice regarding a long-standing issue that has been affecting me for more than two years now. I am a medicine physician myself, so I do not have much experience regarding foot injuries.
Starting in December 2022, I started to endorse a pain based at the lateral and plantar side of my right foot, in close proximity to the 5th metatarsal base. At the time, I was walking up an asphalted hill very quickly, after which I developed an acute pain at the aforementioned site. While the acute aspect has resolved over few weeks, I have continued to endorse a more chronic pain there. It is most aggravated when standing on it, otherwise plantarflexion (such as pushing a brake pedal in a car) and forced eversion illicit the pain. Generally, if I get to rest is for a prolonged time (>1 week), it is substantially improved. So far, I have seen numerous providers including sports medicine, podiatry, and foot surgery. Additionally, testing has been done including multiple xrays of the foot (including weight bearing and oblique views; all read as normal), CT scan with contrast (no bony abnormalities, no os peroneum or hypertrophied peroneal tubercle) and multiple MRIs, which were read as "edematous tenosynovitis of the peroneus longus tendon at the cuboid notch", see attached photo). While the described lesion on MRI would we well compatible with my symptoms, the question still remains what inflames the tendon at the specific site. From a treatment perspective, I have pursued good physical therapy, multiple different orthotics, and shock wave therapy, none of which really led to improvement. Again, the only thing that helps is prolonged rest. At this point in time, even minor things such as standing in the shower, a short walk to the car etc. really trigger it, and it is a very significant impairment of my life.
Few characteristics and things to know: I am 29 years old, have normal body weight. I used to be a competitive figure skater throughout my childhood and was a marathon runner during medical school (never had a complaint like this during all of this time). In 2018, I broke the base of my 5th metatarsal during a run, which was treated conservatively and completely recovered. I have noticed that there is a slight deepening of the skin where the cuboid bone is, was wondering if it might be very mildly displaced and potentially being a trigger. The case itself seems unusual that is isolated to the cuboid notch, it almost feels like the tendon is "trapped" there and doesn't have enough space. For instance, standing on the foot while wearing a compression sleeve really triggers the pain. Based on your experience, I would like to ask a few questions:
1. Is there anything else that you could think of that could be causing this issue? If so, which tests should I pursue in addition?
2. What is your experience with surgery of the peroneal tendon at the site of the cuboid? I have been reading plenty of articles, and most of them actually seem to focus on procedures close to the malleolous. Was wondering how hard it is to reach the plantar site of the peroneus longus...
3. If the cuboid might be causing narrowing at the site, is there any value in doing osteotomy of it to give the peroneus longus more space?

Any help and ideas are extremely appreciated. Thank you so much in advance.
Best,

 

I have the same thing! Did anything help?