Lateral Column Overload

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Summary

Lateral column overload is a somewhat non-specific condition that leads to pain in the outside part of the midfoot. It results from excessive loading through the bones on the outside part of the foot (calcaneus, cuboid, 5th metatarsals) It’s often associated with a high arched foot or a very flat foot, as both of these conditions will increase the force through this part of the foot. Treatment is usually non-operative, with a focus on protecting the area and dispersing force away from this area with the use of comfort shoes or orthotics.

Clinical Presentation

Pain in the outside mid-part of the foot, aggravated by standing and walking, is characteristic of conditions that lead to lateral column overload. Symptoms will often be chronic in nature, without necessarily inciting injury. Typically, patients will have a high arched foot or a flat foot. In either situation, this can lead to excessive force through the outside mid-part of the foot. The clinical presentation of this condition can be similar to other conditions that produce pain on the outside of the foot, such as peroneal tendonitis or flat foot deformity with lateral impingement, or even a stress fracture of the 5th metatarsal.

Physical Examination

Pain will be localized to the outside midfoot. There is often an associated foot deformity, such as noticeable flat foot or a high arched foot. Pain may be exacerbated by manipulation of the joints of the outside midfoot (the calcaneal cuboid and the cuboid 4-5 metatarsal).

Imaging Study

X-rays are typically taken of the foot. They are often negative, other than identifying any type of foot shape (flat foot or high arched). X-rays will rule out damage, such as arthritis to the calcaneal cuboid joint, as well as stress fracture of the 5th metatarsal.

An MRI or bone scan will potentially reveal areas of increased loading activity, either in the anterior calcaneus or cuboid.

Treatment

Treatment for this condition is usually non-operative. It is designed to minimize the force that is going through the outside part of the midfoot. This can be done by modifying the shoeware to have a comfort shoe, which disperses forces away from this area of the foot. Appropriate orthotics to help offload the outside part of the foot may be beneficial. This could include an orthotic with a recessed 1st metatarsal head area for patients with a flat foot, or an over-the-counter medial arch support for patients with flatter feet.

Mobilization of the calcaneal cuboid joint through range of motion exercises or occasionally through physical therapy manipulation, may be beneficial if this joint is involved.


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