stubbing/throbbing/sharp pain

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Happy New Year all,
Hope your 2009 will be a good one.

I have had a 27 yr old female Dx DM (not sure type 1 or 2 yet) Oct 08 – diet control - usual BSL OK

Referred to podiatry for her L/lat side pain, which was started 8/12 ago – constant sharp pain which was getting worse in last few months. Usually worse after lunch time - later day. But less @ weight bearing time.

Massage, ankle brace, elevation, NSAIDs did not help to ease the pain.

-

• renderer – on work boots and squatting a lot
• rest of time wearing thongs or Assics joggers (in good condition) – does not make any difference the pain
• plays netball 1/week à does not make an worse the pain
  
• riding bike often
  
• medium build
  
• Hx several B/ankle sprains in past – never been casted for sprain ankles
  
• feels wobbly B/ankles

Vascular and Neurological Ax: NAD

pain was palpable L/styloid process, L/distal lat mall area - trace peroneus

FPI L/3 R/1

gait not too excessive pron - early heel left


Off work 2/52 during Xmas and back work last week- not change the pain (not improved for off work) --> worse pain later last week and now sharp/stubbing/throbbing @ night - disturb sleep. L/ander ankle clumps during day.

My thought - If peroneus inflammation - why pain gets worse during day? neurological pain?

I issued heat moulded orthotics which did not help the pain.

Could you please give me suggstions?

Thanks

 

Is there any disprepancy in peroneal strength bilaterally? No Hx of trauma, you said she had unstable ankles, did she have even a minor sprain in weeks leading to pain. How is Cuboid ROM on affected side VS unaffected side? Triggers through peroneals? tried lateral wedging to unload peroneals...... Cuboid sx, have you tried manips?? Night pain is a worry. Stress Fz, Malignancy or ischeamic pain 2ndary to DM complications? Does it reduce Sx if she cools feet down?
Will follow this one with interest.

Good luck

MrT

 

Hi MrT,

Thank you very much for your reply.

I did just bried bio Ax on the day, so I have not checked such things. As I thought this can be more neuropathic as rest and non W/B makes the pain worse.

I will try lat wedge as your suggestion.

Thanks again