Essential Insights On Lateral Column Pain

Allan Grossman, DPM, FACFAS, Ann Nakai, DPM, and Jason Sweeley, DPM

Lateral column pain has a variety of possible etiologies ranging from peroneal tendon disorders and cuboid syndrome to skewfoot and postoperative symptoms after plantar fascia release. Accordingly, these authors survey the literature and offer pertinent pearls on diagnosing and treating this condition.

   Lateral column pain is a descriptive term for a myriad of symptoms involving the joints and bones of the lateral column. The lateral column is comprised of the calcaneus, the cuboid and the fourth and fifth metatarsals as well as their respective joints, the calcaneocuboid, the cuboidometatarsal and the intermetatarsal joints.

   Lateral column pain may be due to arthritis, biomechanical abnormalities, acute fractures secondary to trauma or stress fractures secondary to chronic overuse. Other causes include tarsal coalition, peroneal tendonitis or subluxation, extensor digitorum brevis tendonitis, plantarflexion and inversion ankle injuries, cuboid subluxation and iatrogenic causes following surgery.

   In the literature, researchers have described lateral column pain with a number of names including cuboid fault syndrome, lateral plantar neuritis or cuboid syndrome, which has also been called subluxed, locked or dropped cuboid.1 The sheer number of terms used throughout the literature to describe lateral column pain can make literature review a daunting process.

   The literature is divided in reference to biomechanical etiologies of lateral column pain. Various authors have suggested that lateral column pain is associated with neutral, supinated and pronated foot types. Adducted foot types can cause an increase in mechanical pressures that can result in lateral column pain.2 Increased plantar pressures on the lateral column that one may see with neutral to supinated foot types can stress the cuboidometatarsal joints. Identifying the exact biomechanical etiology of lateral column pain is an important factor in providing appropriate treatment.

   A patient with lateral column pain will complain of acute or chronic pain in the area of the calcaneocuboid joint or the bases of the fourth and/or fifth metatarsal. The pain is usually greater with propulsion but may also be present during stance or non-weightbearing. Palpation should isolate the specific area of pain. Tenderness may also be present along the peroneal tendons or the origin of the extensor digitorum brevis muscle.

   One typically diagnoses lateral column pain based on the physical exam as radiographs show little benefit in diagnosis. However, one should rule out stress and acute fractures. Consider tarsal coalition in the younger patient. Due to the nonspecific nature of the pain and the lack of positive radiographic results, accurate diagnosis of lateral column pain can be a difficult process. While computed tomography (CT) and magnetic resonance imaging (MRI) can be useful tools in evaluating the lateral column, they are often unnecessary.

What You Should Know About Cuboid Syndrome

   Cuboid syndrome, which has been defined as “a minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint” is a common cause of lateral column pain.1

   The most common proposed etiologies of cuboid syndrome are plantarflexion, inversion ankle sprains and overuse injuries. Cuboid syndrome is often difficult to diagnose as symptoms can be non-specific. Radiographs are usually negative as there is normally no osseous damage and no notable radiographic changes. Even radiographs taken under manipulation rarely show any changes in the cuboid position.

   As a result, the diagnosis of cuboid syndrome is often based on history and physical findings on clinical examination. Cuboid syndrome can be a result of excessive pronation caused by conditions such as posterior tibial tendon dysfunction or pes planus. While MRI can be useful in identifying localized inflammation of capsule and ligaments, it is often not necessary.

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