You wrote, Craig
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.
In response to Sunny's question
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
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).