Any Advice/opinions on lateral foot pain

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Hi everyone, just wondering what your ideas are on lat foot pain

43 yr old woman has a feeling on lat aspect of left foot from 5th MTPJ to heel. Described as not pins and needles, more sore than tingly and her foot feels 'stupid' it's been going on for 3months but is bothering her more now than initially. It is not constant, if she lies down or rests it takes 5mins to subside then feels ok again.

She has normal-low BP
Levothyroxine for hypothyroidism she's had for 10yrs
No other meds
Otherwise fit and healthy
Mostly non smoker for 10years. Had period of ~2yrs where smoked 2-4/day. Previous to this smoked 15/day from aged 18-33
Brother type 1 diabetes with some peripheral neuropathy
24yr old daughter raynauds affecting her hands

Any ideas/opinions would be appreciated!
Thank you!

 

Along the green area ?

if so any history of back problems ?

Sounds neurological to me with the info we have

 

Plantar fascia (lateral band) pathology?

 

I considered that but does your foot feel stupid and tingly with it ?

SiobhanM832 while Ian and I are throwing out wild guesses some more information might help those who will try to help you with this patient .

 

Sorry guys, I am not treating this patient as I am in Australia and she is in Ireland but I was asked for advice and was just looking for some ideas that I may not think of myself. I am obviously going to recommend she goes to a podiatrist for a full assessment but I was curious as to what it might be and wanted to give her some info. I will post more info when I get it! Thanks!

 

Thought the description was 'more sore than tingly'?

No idea what a stupid foot feel like however

 

My bad read Sort of Tingly not sore than Tingly

 

abductor digiti minimi? not that common a problem area but while we're taking random guesses I thought I'd throw it in

 

Could be lateral plantar entrapment neuropathy at the abductor hallucis area of the foot. You may want to read this paper of a similar one I diagnosed and treated successfully with foot orthoses back about two decades ago (Johnson ER, Kirby KA, Lieberman JS: Lateral plantar nerve entrapment: Foot pain in a power lifter. Am J Sports Med, 20 (5):619-620, 1992).

 

Dear All
An important thing here is the statement, 'the foot feels silly'

weird feet with almost pins and needles (not true paraesthesia), female, 43 years of age rings a loud bell for multiple sclerosis until proven negative.
I would send her to a neurologist. I agree with Kevin's inclusion but when a patient has strange symptoms I always think strange disease and thus one never misses out.
Just a thought
Lovely day here in Fremantle WA for the Sports Medicine Conference.
Regards
Musmed
Paul Conneely

 

Hi all,

I agree with Kevin that it sounds neural - possibly Baxter's neuralgia (entrapment of the proximal slip of the lateral plantar nerve) Is there accompanying weakness of abductor digiti minimi and positive Phalen's test?

Barry Hawes

 

I looked up Phalen's test and was given info regards Carpel tunnel , how is this done regards the foot?
Tim

 

HTML:

http://www.wheelessonline.com/ortho/phalens_test_for_lumbar_stenosis

Found this by googling Palen's test for foot.

I find that many cases of lateral foot pain appear to be referred along the lateral leg into the foot. This is shown in Travel and Simons charts as peroneal referral, but I find that it also can be referred from the ITB or hamstrings. I usually would PNF stretch the ITB, and also the hamstrings and ask whether there were any changes. If the discomfort persists, then PNF the peroneals and ask again. This usually solves the problem. If symptoms return later, then consider the biomechanics, but this is often enough.

Hope this helps.
Ian.

 

Hi
After 40 years in medicine including 20 years in musculoskeletalmedicine, it sometimes pays to listen to the old farts.
Regards
Paul Conneely
Thinking inside the square is easy, thinking outside is not unless practiced often.

 

Dear Siobhan

It sounds like a Sural nerve entrapment/neuritis. These are quite common, and usually present with your described symptoms.

Palpating along the Sural nerve, one should be able to elicit symptoms; Tinel sign, focal painful spot. 5ml of xylocaine w/5ml corticosteriod with needling in this spot will often fix it, or at least confirm the diagnosis if symptoms are relieved.

Sometimes a nerve decompression is necessary, but this is a simple day surgery procedure.

Cheers

Frederick

 

While it sounds neural in nature, it may also be a good idea to check for a leg length discrepancy. She may well be walking with an inverted foot and overloading the lateral column.