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Patient presents:
Sudden onset of pain (without trauma) on Left foot, dorso-lateral aspect of mid-tarsal area.

Pain is minimally reproduced with resisted eversion of foot, and pain is noted with palpation of ehb muscle belly.

Leg musculature is normal and painless.
No swelling or lesions in the area.

Patient was wearing sandals (no heel counter) at the time of pain onset and notes the pain gets worse when walking barefoot - painful to the point of being unable to weightbear. Yet when wearing shoes and orthoses, minimal pain is noted.

It appears to me to be a sprain of ehb.

Any other suggestions?

A sprain of the extensor digitorum brevis muscle would be very uncommon. It would be helpful if you could give us more patient information. You should first consider dorsal midfoot interosseous compression syndrome(DMICS) as a diagnosis since this is very common and may be caused by barefoot walking or walking in low heeled, non-supportive shoes. This syndrome most commonly occurs in overweight women over the age of 50.

Try passively plantarflexing the forefoot on the rearfoot to see if pain is reproduced. I call this test the forefoot plantarflexion test. If it is, then it is likely to be DMICS. I first described this pathology over 8 years ago (Kirby KA.: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997, 165-168) and lectured on it in Melbourne a few months ago in my workshop.

__________________
Sincerely,

Kevin

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Kevin A. Kirby, DPM
Adjunct Associate Professor
Department of Applied Biomechanics
California School of Podiatric Medicine at Samuel Merritt College

e-mail: kevinakirby@comcast.net

Private Practice:
107 Scripps Drive, Suite 200
Sacramento, CA 95825 USA
My location

Voice: (916) 925-8111 Fax: (916) 925-8136
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