Peroneal tendinopathy at the cuboid?

[Dugal]

Hi all,

I've a patient that has a one week history of 3/10 pain following exercise (45 min run) on the inferior aspect of his cuboid. Nil pain on resisted eversion.

Patient is a triathlete. No recent large changes in training.

Biomechanically, he has pronounced femoral retroversion, slight genu valgum and forefoot varus.

Was prescribed full foot orthotics by podiatrist 1 month ago to control excessive pronation. Hi running gait changed noticably from outtoeing to running with his feet parallel to direction of travel (through internal rotation of the hip I believe).

He developed piriformis syndrome 2 weeks after beginning to use orthotics for all training. I've managed to control this with release of piriformis and glut med, strengthening of glut med and max and emphasis of stretching program.

I have previously treated him for patellofemoral disorder.

My provisional diagnosis is peroneus brevis/longus tendiopathy.

Keen to hear your thoughts.

[wutti]

hi your diagnosis sounds possible to me. also make sure if there is some sound like crepitation. sometimes the peroneus longus tendon kind of luxates and "jumps" around in the cuboid area. also if peroneus longus is to tight, it can sublux. the cuboid bone. it often happens after inversion trauma. maybe also exercises for small foot muscles might be usefull to built up the arches of the foot and stabilize it. and muscular imbalances as a result of wrong/bad posture can make the foot instabile.
but i think you are on the right track!!
Cheers

[neurospast]

I am wondering what you are going to do with the information : orthotics for 2 weeks and piriformis syndrome and then later peroneus problems. It seems to me you have to check this because here might be the problem of all his injuries and when you have solved the next problem something else might cause a problem etc etc. Also it might be a good idea to check the back to be shure the problems aren't caused by backproblems like instability

[Dugal]

I'm not particularly sure what you are trying to say.

Back is clear.

Also found relative immobility of the left midtarsal joint, limiting midfoot movement.

[neurospast]

What I am trying to say is that the orthosis might be the cause of the problems and as soon as you get rid of 1 problem the next 1 may lurk around the corner. If you think of how a different movement of the foot (e.g. midtarsal joint limiting midfoot movement) the orthosis might make this problem worse and to my opinion should be looked at prior to do anything else. A bad foot movement might cause peroneus syndrom, knee problems, hipproblems etc. I would like to think that a piriformis problem is closely related to SI problems and if the muscle tone of the pirifomis goes up,some form of neurological problems might occur since the Ischiadicus nerve is close by.
Ps after my personal experience a lot of atletes have not really a good core stability.