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I was hoping for some input on a patient I am treating, may be very obvious to someone else.

Healthy male complaining of pain on the the 5th met head, xrays are clear of fracture.
No corn or callous at site of pain.
Muscles tests do not illicit pain. Palpation of the area does not illicit any pain.
No previous injury to area, most painful at night.
Footwear is correct size and good quality trainers.

Bit confused with this one, any input would be great!

 

If it hurts at night, then its generally not mechanical; think neuro, vascular, tumour.

Having said that --- with him standing try and get your fingers under the fifth and first met heads. If it harder to get under the lateral column --> think what I call "lateral overload syndrome" .... they tend not to be painful on palpation.

 

I agree with Craig that symptoms do not fit perfectly into a mechanical cause, however it's often the non text book cases that are often the trickiest.

How is the foot functioning dynamically?? What is the STJ location?? Is there a LLD?? Is there a problem in the medial column of the foot causing overuse of lateral column??

Bit more info may be helpful...