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Ive have 3-4 patients over the last few months present with this exact symptom:-
Pain approx 2cm proximal to 5th met head only on palpation. No pre-recorded history of injury to the foot.

Any ideas on a possible diagnosis/pathology im dealing with?

Your thoughts would be greatly appreciated

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May just be an "overload syndrome".

Try this:
With patient weightbearing, put finger under fifth met head and "feel" the force needed to dorsiflex it. Do the same to the first met head. --- is there a difference?

In the ones I have seen that are somewhat similar to yours, it is way more harder to dorsiflex the lateral column --> assumption that this is translated into some sort of dynamic overload of anterior aspect of lateral column.

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Craig Payne
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You wrote, Craig
In response to Sunny's question
Then the next practical step to relieve the pain may be to pad or wedge the lateral column/forefoot and see if it responds? If so you are looking at orthoses.
In the background with that force differential between the lateral and medial forefoot would you be expecting to see an everted forefoot to rearfoot or a plantar flexed first rather than any other alignment?

The location of the painful area aligns seems also to fit with a trigger in Add Digiti Min, which could be resolved easily with manual compression or dry needling into it.

Further, I'd also be looking at how 'freely' the lateral column was able to move against the rest of the forefoot and wouldn't be surprised to find that it may well be 'stiff'. In which case, mobilising the rearfoot and lateral cuneiform and cuboid may again resolve the problem.

So, at first visit I'd mobilise the foot, treat the trigger and send the patient off with possibly some lateral padding (if it wasn't already completely resolved).



Cheers
Shane

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Shane Toohey

No idea!! We have adapted our supination resistance device to measure the differences in forces to elevate the medial and lateral columns to further investigate this, so watch this space.

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Craig Payne
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God put me on this earth to accomplish a certain number of things - right now I am so far behind, I will never die.

Must be fate.
i have just seen the same symtoms on a patient - 1cm behind the 5th met head.
medial column stiffness was less than lateral with a short 1st ray.
I am trying an FFO with a mortons extension to try and load up the medial column and a large cubiod pad.
If this works then will let you know.
Just out of interest there was no triiger point in the add dig mini or cuboid stiffness etc.
weird one

Phil