sudden onset of severe foot pain without an injury
(New Canaan, Ct.)
I am a 60 year old woman who is very active with spinning, elliptical, and weight training. I love to work out and do so daily. Yesterday I got up from a chair and noticed that my right foot was hurting. Several minutes later the pain became so severe that I almost fainted. The pain was in my right foot on the top right side a little in front of the ankle. I thought maybe I had a stress fracture. I was unable to walk even with a walking boot and crutches. I iced it, took some Advil and valium and the next morning the pain was nearly gone. What type of foot pain could cause such pain, without an injury and then go away? I'm wondering if I can return to spin? I will see a doctor but can not get an appointment with a foot specialist for two weeks.RESPONSE
Based on the part of the foot where the pain occurred and the fact that there was no history of trauma, but apparently you are very active, my first thought would be a subluxed cuboid
bone. This bone is located in the area of the foot that you describe and could very well cause pain for no apparent reason and just as quickly go away as the bone moves back into place.
In very active individuals the most common cause of this condition is what is known as repetitive stress where a certain motion, mainly, some degree of inversion where the foot constantly bends inward will cause a loosening of the ligaments
that attach the cuboid bone to the adjacent bones and thus the cuboid bone will "move" and become painful. If the bone is pushed back into place, there is a good chance the pain will subside.
This is a difficult problem to diagnose because a routine x-ray will generally not show the movement of the bone. Sometimes an MRI will be able to show damage to the adjacent ligaments.
The diagnosis is usually made on the basis of history and palpation of that portion of the foot.
Of course, this is not the only cause for pain on the outside of the foot, but based on your story would be the most likely.
I may be stating the obvious here, but of course the pain could return, for no apparent reason, if the cuboid bone subluxes again.
If this turns out to be the cause of your foot pain, there are things that can be done to minimize the recurrence. The most common treatment is through the use of a cuboid pad build into an orthotic device that helps keep the cuboid bone in place. You will also need to take a look at some of the athletic activity you engage in and determine if any of them are aggravating the problem.
You are correct in seeing a foot specialist for this type of problem as this type of diagnosis would not be familiar to other types of doctors.
You mention a stress fracture as one possibility but in general, a stress fracture will continue to hurt and the pain will not disappear spontaneously.
Marc Mitnick DPMDISCLAIMER