Orthoses and Balance in the Aging Patient
James McGuire, DPM, Milad Manouche, BA We tend to take
Patient
Female, 24 years old, 125 lbs.
Complaint
Dull, throbbing pain on the lateral plantar aspect of the left foot, just proximal to the fifth metatarsal base.
History
The patient has been a runner for the past five years. She runs 30-40km per week. No previous leg or foot problems.
Clinical Observations
The patient demonstrates a 4 degree subtalar varus and a 3 degree forefoot valgus bilaterally. Palpation of the area just proximal to the fifth metatarsal base elicits acute pain. X-ray findings are negative.
Diagnosis
Cuboid peroneal syndrome
Discussion
Symptoms occur along the lateral aspect of the plantar surface of the foot. The condition must be differentiated from long plantar ligament strain, the difference being that the long plantar ligament strain begins as a slightly painful entity upon arising and becomes worse as the day progresses. Cuboid peroneal syndrome is immediately painful upon arising and constantly throughout the day. The condition is one of tendonitis of the peroneus longus tendon as it passes through the groove on the under surface of the cuboid. The condition is usually seen in a high-arch type foot. Forefoot valgus is commonly present.
Management, acute
Cortisone injections plus lateral type cushion padding from the head of the fifth metatarsal to the anterior aspect of the calcaneus carried across the whole width of the foot. Persistent cases respond well to orthotic therapy.
Management, chronic
Rarely, operative intervention in the form of re-grooving of the peroneal groove on the cuboid and thinning of the peroneal longus tendon is needed.
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