Hi all
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Had this patient in the other day for the 1st time . Just got a look at the MRI ( see below) Note I´m not the greatest reader of MRI so have 2 views see what you think.
Ive not seen the cuboid stress fracture before so though I would get some advice.
60 yr old female
Slightly overweight. Loves to walk ( 10 km everyday), cycle and swim.
Injury hx: From Jan 2008 plantar fascia pain at insertion Left still not painfree.
Right fracture fibula.
Current problem Hx: Pain began in June 09, Was cycling for exercise due to Cronic heel pain, Felt pain in the lateral column of the left foot, The pain began as dull background pain and then slowing increased when Cycling or walking. As the pain was dull Pt thought it was Plantarfascia related.
Pt got sick of cycling went for short walks same dull pain then one day went for a 1.5 hour walk very painful after. Could not walk without sharp pain in lateral column.
Rested not tx went to have xrays in oct nothing seen on Xray ( I have not seen them ). Went to a orthopedic surg who told her is was from her back.
Had back xrays and MRI nothing!!!! The Dr who read the MRI thought it was a bit strange so ordered foot MRI and Cuboid stress fracture was noted.
Was referred to Physio no help, then went to an Osteopath no help tried Zone therapy no help.
Came to me nearly 8 weeks after MRI.
Biomex highlights.
Medial deviated axis.
Forefoot Supinatus
Slight HAV´s
Increased Q angle
Increased ROM STJ, MTJ
Low supinatory resistance left side ( pretty sure she was helping me she is bit of a stressed pt)
Palpation pain.
Cuboid tender.
Medial aspect sinus tarsi.
pain in cuboid in INV/EV of MTJ against STJ.
PL and PB as pass around lat mall.
Gait a complete mess walks with a large limp to reduce load on left foot.
Ive got some tx ideas but thought I would get yours.
Concerns with treatment options. If I reduce load on PL and cuboid with lat skive increased plantarfascia and sinus tarsi. Im abit concered about compression forces also
What do you think ?
Tags:
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Spring Ligament Failure as factor in Plantar Fasciitis
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Forefoot Injuries in Athletes: Integration of the Movement System
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Spring Ligament Failure as factor in Plantar Fasciitis
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Forefoot Injuries in Athletes: Integration of the Movement System
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