A 16 year-old female basketball player presented with chronic left foot pain of two months duration. She could not recall a specific mechanism of injury or traumatic episode. Her past history was significant for Achilles tendonitis and previous ankle sprains. This pain was located over the mid/lateral aspect of the left foot both during activity and rest. She described the pain as a “dull ache” with occasional “shooting” pains. She also noted occasional tingling of the lateral foot but denied numbness and weakness of the lower extremity. Her menstrual and diet history were unremarkable.

Inspection revealed normal gait without soft tissue swelling or ecchymosis. The patient demonstrated bilateral pes planus foot deformities. Active and passive ROM was full and equal bilaterally. Tenderness was noted over the fourth and fifth metatarsal head and shafts along with the cuboid bone. Peroneal and tibialis posterior strength was full with mild pain upon resisted eversion. There was no pain with single toe raises. Distal neurovascular findings were within normal limits. Anterior drawer, talar tilt, squeeze test, and Thompson test were within normal limits. Pain was not reproduced with tapping over the tarsal tunnel. Gross sensation, pulses, and reflexes were within normal limits.

Initial Differential Diagnosis Based on the History and Physical: