Diagnosing the lateral column foot pain in athletes
This article discusses lateral column foot pain in athletes as almost 16% of all sports related injuries are foot injuries. There is minimal literature specific to lateral column foot pain in athletes. The lateral column of the foot includes the calcaneus, the cuboid, the fourth and fifth metatarsals and the calcaneocuboid, cuboid metatarsal, and intermetatarsal joints, the cuboid being the cornerstone.
The calcaneus is the most commonly fractured tarsal bone and can be divided into stress, intraarticular, and anterior process fractures. Examination is not specific, but a medial to lateral calcaneal squeeze is more likely tender than the focused plantar tenderness of plantar fasciitis. A single-leg hop test reproducing calcaneus pain in the affected foot is suspicious of injury.Patients complaining of pain similar to a lateral ankle sprain may have an anterior process fracture. Maximum tenderness will typically occur 1 to 2 cm more distally in the region of the sinus tarsi or over the calcaneocuboid joint. Acute avulsion fractures typically present after an inversion/adduction injury or a sudden change in direction. Stress fractures of the second, third, and fourth metatarsals make up 90% of metatarsal stress fractures. Patients often present poorly defined forefoot pain. The pain is initially intermittent and then worsens with increasing activity.Cuboid syndrome .The precise mechanism of injury is poorly understood. There is no definitive diagnostic test. The pathomechanical origin of cuboid syndrome is thought due to a disruption of the calcaneocuboid joint, specifically injury to the calcaneocuboid portion of the bifurcate ligament Cuboid syndrome clinically is variable. Patients can present with localized pain over the cuboid, especially on the plantar aspect, but often present with generalized lateral foot pain. A subluxated cuboid may present with a slight depression over the dorsum of the cuboid and plantar cuboid prominence. Two unvalidated tests can be performed: the midtarsal adduction test and the midtarsal supination test. Pain and instability constitutes a positive test.Os peroneum syndrome. Patients can present with chronic or acute pain over the lateral foot. Physical examination will reveal pain over the lateral plantar aspect of the cuboid. Resisted foot eversion should elicit pain.
Correct diagnostics of the lateral column is challenging. The clinician needs to have an understanding of anatomy and biomechanics. Suspicion should be raised if patients do not respond to standard treatment. A quick and accurate diagnosis aids in reducing morbidity for the athlete and allows a safe return to activity.
> From: Traister et al., Curr Sports Med Rep 6 (2014) 370-376. All rights reserved to The American College of Sports Medicine.Click here for the Pubmed summary.