Painful Os Peroneum Syndrome Presenting as Lateral Plantar Foot Pain

Lateral plantar foot pain can be caused by various entities, and the painful os peroneum syndrome should be considered in the differential diagnosis. Recent developments in musculoskeletal ultrasonography are very useful for initial diagnosis. We discuss a 69-year-old female who experienced lateral plantar foot pain for over one month. Through physical examination, radiography, ultrasound and magnetic resonance imaging, she was diagnosed with the painful os peroneum syndrome with a chronic fatigue fracture of multipartite os peroneum and peroneus longus tenosynovitis, for which she underwent surgery. We herein report this rare condition and reviewed the relevant literature.

A pilot study: Efficacy of simple customized shoe-insert to decrease abnormal plantar pressure in patients with plantar foot pain.

Objective: To evaluate the efficacy of a simple customized shoe-insert in decreasing abnormal plantar pressure and in changing the pain score in patients with chronic plantar foot pain Methods: Ten patients with chronic plantar foot pain were initially recruited from the outpatient unit of the Department of Rehabilitation Medicine, Siriraj Hospital. The simple customized shoe-inserts were fabricated from 2 layers of EVA foam. Some pieces of foam were attached to the specific locations between the two layers by using the subjects’ foot pressure graph as blueprint. The plantar pressures were measured during walking by digital foot scanning (FootscanTM insole system), with and without the customized shoe-inserts in. The average pain scores were altogether reported by the patients in terms of a visual analog scale. The same measurements were repeated again with the shoe-inserts in after 2 weeks of use. Results: Nine participants (3 males, 6 females) were evaluated completely. The diagnoses were plantar fasciitis (all 9 subjects) and matatarsalgia (3 of the 9 subjects). Immediately after applying the shoe-inserts, foot pressures were significantly decreased (p = 0.011) when walking. However after 2 weeks, the pressures were no longer significantly reduced (p = 0.859, p = 0.173) compared to the baseline before fitting. Also, for the pain score change, most subjects initially reported pain relieved (7 in 9 subjects), but the second visit showed no significant difference (p = 0.081) compared to the first day before using. Conclusion: The simple customized shoe-inserts could potentially decrease average plantar pressure as well as the average pain score in most cases. However the pain score reductions were not significantly different after 2 weeks of the device applications. Future investigations with an appropriate sample size are required to precisely conclude the efficacy of the shoe-inserts.