I mostly see corns-n-callus but I'd like to be more confident with the occasional MSK case that walks in. Can anyone offer any advice on how I should progress this one?
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A 52 y/o white male with a history of episodic pain in the cuboid region of left foot.
He runs 3 times a week, typically a total of 25 miles per week. He also cycles about 40 miles a week. Running is on-road during the winter, both running and cycling routes includes steep hills. Also does some dog-walking.
He does not feel any pain while running but it comes on soon after and persists for a variable time (2 days to 2 weeks). It is painful to walk on barefoot, less so walking in supportive shoes and not at all (curiously?) running. There is no pain non-weightbearing.
I am not an experienced biomech pod but over the last 6 months I have twice successfully manipulated the cuboid (surprising myself!). My last attempt however was unsuccessful and the symptoms seem worse, perhaps because they are persisting for longer from a failed manipulation, or perhaps because the diagnosis is amiss. The current episode has been going on for 2 weeks now.
I am wary of manipulating again without further insight, in case I do more harm than good. As a stop-gap I have strapped a small pad of high density poron over the cuboid, in probably a forlorn attempt to stabilise the joint. The patient says he felt more confident running with the strapping on, but afterwards at home it was as painful as before.
No relevant medical history.
There is no swelling and no difference that I can feel between the left and right feet in the cuboid area. The tenderness is very localised. Feet are mildly pronated (and he runs wearing a basic orthosis with a 3deg medial rearfoot wedge). Ankle dorsiflexion is good with knee bent but limited when straight. End of range dorsiflexion brings on the cuboid pain slightly but no other foot movements provoke it. First MPJ feels good weight-bearing and non, although heavy medial IPJ callus suggests some issue there.
Unsurprisingly his preference is to find relief without having to stop running. It's only in writing this up here that I can see one obvious thing would be to try him wearing good shoes indoors for a couple of weeks - I've always thought of it as a post-exercise effect when perhaps it's more a lack-of-support effect?? He's tried Ibuprofen tablets and gel to not much effect.
What else should I consider as cause and what else should I try as treatment.
Thanks for any advice!
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Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes
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Lower Extremity Alignment and Hallux Valgus
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Foot Bone Marrow Edema after 10-week Transition to Minimalist Running Shoes
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Lower Extremity Alignment and Hallux Valgus
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