Members do not see these Ads. Sign Up.

Hi guys,

I saw a patient this afternoon that I'm puzzled by what the diagnosis or course of action is and I was hoping if you could help me shed some light.

This is a 35 year old lady who gave birth to 7 months ago and is experiencing pain in her right lateral dorsal midfoot. No history of trauma to the foot. Started shortly after she gave birth. She has a medical history of asthma and hyperventilation, no known allergies.

She describes this pain as:
- Sharp pain that is most severe in the morning out of bed and after long periods of non- weightbearing; first step pain; 7/10
- Pain is 0/10 at best and at rest
- Pain improves after warming up and subsides entirely thereafter.
- Does not radiate.
- She is able to engage in her daily exercise activities without hinderance as pain disappears

Upon clinical examination:
- No pain on palpation of metatarsals, intermetatarsal spaces, extensor tendons, peroneal tendon, sinus tarsi, ATFL, talus or cuboid.
- No pain on resisted muscle testing evertors, extensors or dorsiflexors
- No pain on palpation of lateral dosal midfoot, which is the site where the pt complains of pain
- Pain is only reproduced on squeezing the foot medial-lateral in the midfoot region. Pt reports sharp pain on lateral dorsal midfoot when this is done so.
- Pain on weightbearing active inversion, when weight is being placed on the lateral border of the foot.
- She has hypermobile foot joints, and a wide and splayed foot due to this hypermobility. Otherwise no remarkable biomechanical findings that sticks out.
- X-rays taken show no remarkable findings

I'm thinking that this is condition is muscular in origin but struggling to figure out what it is. If any of you could lend me your two cents, that will be greatly appreciated. Thanks!

 

It is likely lateral dorsal midfoot interosseous compression syndrome.

Try reading this thread also: Lateral midfoot pain in runner.

Hope this helps.:drinks

 

Hi Kevin,


Thanks alot for your prompt reply. I'll let you know how I go and keep you updated on the pt's progress when she comes in next. Do you have any differential diagnoses for this presentation?


Regards,
Boon

 

I experienced forefoot pain after childbirth 4.1kg no.1 baby then it increased after 4.5kg second baby arrived. I always walked and pushed them in the pram and of course pain was worse the following day. After realizing I needed to buy a pram with larger, swivel wheels that was much easier to maneuver my large brood the pain subsided. Also, used a variety of orthoses and sport shoes.

 

I have observed this frequently with habitual weight bearing on the opposite side posterior. The reflex is to elevate the 4th and 5th metatarsals to bring the weight back onto the foot. the pattern places foot fall pressure on the 3rd or 4th metatarsal heads. on non weight bearing the habitual pattern remains keeping the interosius space irritated.
Sometimes manipulation will pop the transverse alignment into an arch instead of a depression. Usually stride symmetry correction is necessary to prevent re-occurrence.