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A 30 something lady who presents with lateral foot pain that is most aggravated by stairs and slightly less so with walking. She indicates pain precisely at heel rise and localized it to the lateral mid foot. She is point tender about the Cuboid region. Her VAS pre- treatment pain is 6/10 ambukating stairs. After Applying leukotape juxtaposing the course of Peroneus Longus the pain rating on stairs drops to 2/10. Without tape, a slight degree of relief occurs with the addition of a Cuboid pad to her Powerstep insert. Two final pieces of information: 1) she had a Lifranc fusion 3 years ago, and 2) she tends to wear very flexible soles athletic shoes. My question is this. Would it be logical to prescribe a carbon graphite insole with a Cuboid pad that would lessen the stress to this area of the mid foot as the next step before heading down the path of a custom orthotic?

 

It depends on what you thought the problem was. Is it a peroneus longus tendonitis, or midfoot arthritis from the midfoot fusion, or a cuboid subluxation, or psychosomatic. I like picking a pathology and aiming the device at what I think the problem is.

 

It seems more articular, Cuboid articulations both proximal and distal. I have no imaging to confirm OA.

 

Since it seems to hurt more with push off (my impression from the little you wrote), it could be lateral plantar ligament strain. Although Lisfranc's injuries also hurt with push off. Sometimes there is no obvious diagnosis and you just pick one and then change treatment if that fails. I could see an otc device helping a subluxed cuboid and a plantar lateral ligament strain. Or it might not, if the plantar lateral ligament strain was caused by a partially compensated varus.

 

Lateral Dorsal Midfoot Interosseous Compression Syndrome (a.k.a. Lateral DMICS).

https://podiatryarena.com/index.php?threads/dorsal-midfoot-interosseous-compression-syndrome.1980/

 

1st question, why at age 27 did she have a LisFranc fusion? That said, simply mobilizing the cuboid will usually and spontaneously resolve her symptoms. And since her foot is already partially fused, be careful with too much motion control.

Howard