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I had a runner come in to my surgery the other day. He was complaining of pain around the styloid process when running and for about a week after the run. On further examination there was bruising and inflammation along the course of the peroneous brevis and pain on palpation. No medical history other than a previous lateral ankle sprain on the foot in question.

MSK assessment: NAD non weight bearing. When walking very heavy lateral heel strike with wear and callus build up on the 2nd met. The hallux is extremley dorsiflexed so much so that it causes holes in most of the pt's shoes. When standing there is slight pronation.

I have suggested rest, ice and stretching/strengthening for the acute injury as the calf muscles were very tight. Provisionally I have provided an orthotic with a 3 degree lat heel wedge and a 1st met cut out.

I was just wondering if any one had any ideas on the matter. All comments welcome. This is my first post so please be kind.

 

Hi, what were the supination resistance and STJ axis location?

Alwin

 

Putting 3degs lat heel wedge might be a good idea to reduce the tension on the peroneal brevis.. and of course, it's good to have rest, ice, stretching/strenghtening exercise. If you haven't check for Supination resistance test and STJ axis location, it might be a good idea to do so.

Alwin

 

Elle,
What caused the bruising? With that description I'd immediately think that there might be a ruptured peroneus brevis. Was there? (Results of muscle testing) Any thing else in gait? (Late stance phase pronation, limp?) Why the callus sub 2nd? (Long 2nd mobile 1st?) What happens to the hallux in static stance, non weight bearing? Are the extensor tendons visible?

Did you see the thread on how to present a patient? It's really hard to give advice with the amount of information you've given us.

Eric