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An active recreational athlete came to our orthotics&shoe store after his sports injury orthopaedic surgeon found nothing orthopaedically wrong with his leg pain, recommended rest, NSAIDS, ice and orthotic insoles.

As an orthotic fitter I feel extremely uncomfortable being left to decide on my own on a try-and-error basis what kind of insoles may do justise to a person in pain and without a diagnosis. I would really appreciate knowledgeable opinions - if it's possible to form one taking into account the scant information I have regarding his condition - does anything below sound like he may benefit from neuromuscular assessment? Second opinion from another orthopaedic surgeon? (There are no podiatrists in our country and the former mostly specialize in surgical treatment, so he is likely to end up with another similar prescription for insoles at the discretion of a sales person).

The person in question is a 30-odd years old man, normal BMI, it's the third day he has been experiencing sudden occasional sharp shooting pain in the lateral aspect of his left leg, approximately around the proximal origin of the peroneus brevis muscle. The pain is felt only when his toes and forefoot pressed against the ground and the forefoot is slightly supinated, anke is maximally plantarflexed. The pain is random, it doesn't occur with every toe off phase of gate cycle. There's no pain, swelling or bruising in the foot itself. No history of recent injury, no ankle sprain, the day it started he played tennis on what he felt was a very hard surface, new and uncomfortable for him. He's able to reproduce his pain voluntarily (and he's probably doing this quite frequently trying to find out if the pain is still there). His everyday shoes are thin-soled plimsoll trainers. Luckily for me and probably for him the shoes wouldn't accomodate anything less compact than gel arch supports he had in there. He plans to return with roomier shoes. I'm trying (in vain) to find information regarding any established orthotics treatment applicable to his (unknown to me) condition. Basically, I want him to come in with a diagnosis, but I don't know should I ask for it directly since his doctor has already said he's ok.

 

Sounds like you have come up with a starting diagnosis already

Peronous Brevis issue

What I would suggest is trying a lateral wedge or something similar added to

think about what the PB does and try to reduce the work of the muscle with a device a lateral wedge will be a good starting point so see if the symptoms reduce

 

Thank you for the answer and your time, to my shame it turned out I was un unreliable narrator. An hour ago he dropped by to say that his gel arch supports somehow worked for him, the pain is mostly dull today (despite his constantly jumping on his forefoot to make sure it is more dull than yesterday). The crucial point is that, according to today's account the pain starts posterolaterally around the place where the calcaneal tendon attaches to the gastrocnemius/soles muscles and then refers 5-8 cm proximally. And there's a history of recurrent ankle sprains in his problematic left foot, and the doctor recommended insoles to control his excessive pronation. I think next time I see him I should ask for a signed and sealed diagnosis from his doctor!