Welcome to the Podiatry Arena forums

You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members, upload content, view attachments, receive a weekly email update of new discussions, access other special features. Registered users do not get displayed the advertisements in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!

  1. Everything that you are ever going to want to know about running shoes: Running Shoes Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
  2. Have you considered the Critical Thinking and Skeptical Boot Camp, for taking it to the next level? See here for more.
    Dismiss Notice
  3. Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
    Dismiss Notice
Dismiss Notice
Have you considered the Clinical Biomechanics Boot Camp Online, for taking it to the next level? See here for more.
Dismiss Notice
Have you liked us on Facebook to get our updates? Please do. Click here for our Facebook page.
Dismiss Notice
Do you get the weekly newsletter that Podiatry Arena sends out to update everybody? If not, click here to organise this.

Forefoot inflammation/pain, Spect-CT shows cuboid uptake

Discussion in 'Biomechanics, Sports and Foot orthoses' started by markjohconley, Sep 25, 2012.

  1. markjohconley

    markjohconley Well-Known Member

    Members do not see these Ads. Sign Up.
    55 y/o caucasian female presents with 3 month history of unilateral forefoot pain / inflammation since chemotherapy.
    Spect-CT imaging reveals increased uptake only at "superior aspecto of cuboid, extending into talo-navicular joint" of both feet.
    Supination resistance moderate, no palpable peronei tendons. No hx of ankle sprains.
    Rearfoot valgus wedges have reduced the pain level whilst a cuboid pad increased the forefoot pain.
    Do I need to refer this pt to a clinician familiar with mobilisation/manipulation?
  2. markjohconley

    markjohconley Well-Known Member

    Not enough information. Forget the pt.

    Increased uptake at the "superior aspect of the cuboid" bilaterally. I thought of dorsal interosseous compression syndrome at first, that's why I would try a cuboid pad. What would first come to mind if you only had the Spect-CT report to go by?
  3. David Wedemeyer

    David Wedemeyer Well-Known Member

    Mark is there anything in her history that indicates inversion trauma or jumping activities that may have subluxed the cuboid? Is she tender to palpation of the cuboid or base of the 5th ray?
  4. markjohconley

    markjohconley Well-Known Member

    Goodaye David, no pain could be elicited on palpation or passive movement of her calcaneo-cuboid, talo-navicular, intra-tarsal and tarso-metatarsal joints. She could not recall any trauma to her feet/ankles. Thanks for replying, mark
  5. Ian Linane

    Ian Linane Well-Known Member

    Hi Mark

    Excuse my ignorance if I have missed something in your original post but when you mention forefoot it is the following questions that come into mind:

    1 Where in the forefoot is the pain being experienced (intermetatarsal - soft tissue, metatarsal head area etc)?

    2 At what point in the gait cycle is she experiencing the pain (heel contact, midstance, propulsion)?

    3 Does the pain only occur on weight bearing part of cycle and ease off when the foot is unloaded?

    • If it is intermetatarsal then an option I use here is soft tissue mobilisation to the area but in specific way. Happy to explain this if it relevant.
    • If it is in the met head area on propulsion then one option is whether MWM to met heads might be beneficial. Again happy to explain this if it is relevant.
    • Interestingly you could try an MWM on the cuboid as well, if you thought that area warranted something.
  6. phil

    phil Active Member

    MWM? Some kind of mobilisation?
  7. Ian Linane

    Ian Linane Well-Known Member

    Hi Phil

    Yep. It stands for Mobilisation with Movement. My apologies for assumptive short hand in this case. Was in a rush replying.

    These are various techniques developed by Physiotherapist Brian Mulligan since the 1980's (I think). Brian has developed a whole range of techniques that are related to the spinal mobilisation but when applied to peripheral joints they are known as above, shortened to MWM's.

    I use certain types of them for metatarsalgic pain, amongst other things.
  8. markjohconley

    markjohconley Well-Known Member

    Thanks Ian, I have recontacted the patient.
    The pain was not reproduced at the clinic.
    She states she only feels it after several hours static weightbearing.
  9. musmed

    musmed Active Member

    Dear Ian and Mark et al.

    Some things that are important
    1. why the chemo?
    2. has the chemo damaged the articular cartilage?

    if not

    Remember that a higlighted scan as in her case the cuboid and the patient's pain must superimpose if not it should be ignored.

    regarding her pain. If the pain comes on after standing for a while she is standing on her walking foot. That is the medial column

    Someome who knows mobilisations like Ian would solve her problems
    a lovely 24 sunny day here
    regards from the south coast

    paul Conneely

Share This Page