Unexplained foot pain

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Hi,
Can anyone help? I had a man in his thirties present to me with pain in the dorsum of his left foot in the region of his lateral cuneiform. This has practically stopped him walking as he can hardly bear weight on the foot due to the pain. The interesting thing is that it came about after a good nights sleep and there was no history of trauma. Passive inversion of the foot reproduces pain and lateral compression of the forefoot causes the pain to radiate from the forefoot up to the central point of pain. He had difficulty in actively dorsiflexing the foot due to pain also. My patient tells me that he works as a teacher and runs up and down stairs for most of the day, and prior to this injury he had suffered from symptoms akin to a neuroma on the forefoot. He also told me that about a week ago he had felt something 'give' in his foot whereupon he quickly diverted his weight as he felt that he was going to injure himself. But nothing came of this until he woke up the other day from a good nights sleep. Any ideas?
Cheers Poduk55

 

Dorsal Midfoot Interosseous Compression Syndrome

 

Hi Craig,

Thanks for that advice; that all seems to check out. When I saw him the following day he told me that the pain had eased a little but he had since developed an area of hot erythema on the dorsum at the pain site. There doesn't appear to be a portal of entry on the skin. I applied low dye strapping and this helped him further but now he is presenting with even worse pain in the foot. Any ideas?

Thanks so much

 

Hi

I agree with the DMICS - this is probably causing impingment of the interosseous branch of the deep peroneal nerve and therefore causing the retrograde radiating pain to the central point. Just a possibility?

 

Could the localised problem in the foot be a conversion reaction due to an underlying psychosomatic disorder?