Unusual foot pain in 17yo Male

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I had a 17yo male present to me complaining of long standing foot pain.
Pain began approx 5mths ago and is only apparent when playing sport not when walking or normal every day activities

Pt plays basketball 1x week and rugby 1x week and trains for rugby 2x a week.

Pain is "strong tingling, sharp but also achy" at the plantar surface of foot posterior to the styloid process. Palpation of the area revealed no pain at the MTPJ or metatarsal or attatchments of any tendons but strong tingling approx 7-10mm posterior to the styloid process. Pain is bilateral.

There is also pain at insertion of Tibialis Posterior and the muscle belly.

Pt has had a physio taping his feet which is not making any difference to the pain on the lateral side of the foot.

Gait is pronated at the mid- tarsal area and the navicular drops to approx 1cm from the ground.

I trialled inversion and eversion taping of the foot, both of which made the tingling apparent. I also trialled D-filler padding and padding of the 5th ray to help stabilise. 5th ray padding felt "ok".

I am now at a dead end, would anyone have any ideas to enlighten me?

 

Katie:

The only structures in that area that make sense to me causing pain is the lateral component of the plantar aponeurosis, which I call lateral component plantar fasciitis (Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002) or it could also be the peroneus longus tendon. However, I have never seen injuries to either of these structures causing a "tingling pain". Is the pain/tenderness more plantar or more lateral? Does deep palpation plantarly just proximal to the styloid process elicit tenderness? Does eversion testing of peroneus longus elicit pain? Try a 6 mm heel lift that has its distal edge at the calcaneal-cuboid joint in each shoe when playing sports....does that help pain while running?

 

Just an outisde thought, tarsal tunnel pathology with irritation of lateral plantar branch of posterior tibial nerve? Sural nerve and first branch of lateral calcaneal nerve may also be worth a look. Nerve blocks may be useful diagnostically. Check his sports shoes as well and make sure there is no irriatation to nerves

 

Thanks Kevin and Adrian,

Kevin, the pain is on the plantar surface not lateral. Deep palpation proximal to the styloid process and eversion testing do not elicit pain, which is why I am perplexed! I will try the heel lift.

Adrian, yes I too thought it may be a strange presentation of tarsal tunnel syndrome due to the pain description. Will see what happens when I review him.

Thank you again

 

This sounds like a restriction in cuboid ROM. Manipulation of the cuboid is a very simple maneuver. If you are not familar with this, go to www.Vasylimedical.com, and there are articles (with pictures) on this procedure. Works wonders.

For those interested, I will be in Australia in May doing a series of seminars including lower extremity manipulations/workshops. The Vasyli website has the details.

Howard