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Cuboid Stress Fracture

Discussion in 'Biomechanics, Sports and Foot orthoses' started by mike weber, Dec 8, 2009.


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    Hi all

    Had this patient in the other day for the 1st time . Just got a look at the MRI ( see below) Note I´m not the greatest reader of MRI so have 2 views see what you think.

    Ive not seen the cuboid stress fracture before so though I would get some advice.

    60 yr old female

    Slightly overweight. Loves to walk ( 10 km everyday), cycle and swim.

    Injury hx: From Jan 2008 plantar fascia pain at insertion Left still not painfree.

    Right fracture fibula.

    Current problem Hx: Pain began in June 09, Was cycling for exercise due to Cronic heel pain, Felt pain in the lateral column of the left foot, The pain began as dull background pain and then slowing increased when Cycling or walking. As the pain was dull Pt thought it was Plantarfascia related.

    Pt got sick of cycling went for short walks same dull pain then one day went for a 1.5 hour walk very painful after. Could not walk without sharp pain in lateral column.

    Rested not tx went to have xrays in oct nothing seen on Xray ( I have not seen them ). Went to a orthopedic surg who told her is was from her back.

    Had back xrays and MRI nothing!!!! The Dr who read the MRI thought it was a bit strange so ordered foot MRI and Cuboid stress fracture was noted.

    Was referred to Physio no help, then went to an Osteopath no help tried Zone therapy no help.

    Came to me nearly 8 weeks after MRI.

    Biomex highlights.

    Medial deviated axis.
    Forefoot Supinatus
    Slight HAV´s
    Increased Q angle

    Increased ROM STJ, MTJ

    Low supinatory resistance left side ( pretty sure she was helping me she is bit of a stressed pt)

    Palpation pain.

    Cuboid tender.
    Medial aspect sinus tarsi.
    pain in cuboid in INV/EV of MTJ against STJ.
    PL and PB as pass around lat mall.

    Gait a complete mess walks with a large limp to reduce load on left foot.

    Ive got some tx ideas but thought I would get yours.

    Concerns with treatment options. If I reduce load on PL and cuboid with lat skive increased plantarfascia and sinus tarsi. Im abit concered about compression forces also

    What do you think ?
     

    Attached Files:

  2. pod29

    pod29 Active Member

    Just my thoughts from first glance.....

    What do you think are the contributing factors from her gait pattern (if you can ascertain these from her defensive gait)? ie. direct impact/compression forces on the cuboid from GRF, anterior/posterior compression from calc and mets 4-5, rotational or torsional forces from the PL tendon?

    Or.. if the cycling was the initial cause, is there anything that may prolong/prevent a timely healing?

    If you think you can identify the cause of the stress Fx, then work out what is the best way to reduce these forces?

    Will a lateral skive actually reduce load on PL? A device that increases the dorsiflexion stiffness of the midfoot in late midstance would probably be effective at reducing load on this muscle without having to apply an external pronation moment to the subtalar joint. Maybe this will be effective without having negative effects on sinus tarsi and plantar fascia.

    I've seen one of these, was induced after failed surgery for flat foot:bang:
    resolved really well with a neutral shell, that had a really close contour through the whole lateral column. We didn't use a cuboid notch/accommodation just a close contour through the lateral mid-foot. But again design specifics will be relative to the foot and aetiological forces.

    Or, you can put her in a boot!

    Cheers
     
  3. Thanks Luke See how we go.
     
  4. rhetoric66

    rhetoric66 Member

    Hi Michael and Luke,
    I realise that this is an old thread but I recently had a nearly identical case and wondered if you could explain in a little more detail your proposed orthotic prescription

    "A device that increases the dorsiflexion stiffness of the midfoot in late midstance would probably be effective at reducing load on this muscle without having to apply an external pronation moment to the subtalar joint. Maybe this will be effective without having negative effects on sinus tarsi and plantar fascia"

    This sounds excellent, but how is it achieved?!!

    Kind regards,
    Scott.
     
  5. Hi Scott,
    1st I can´t give you any more information on my patient as she was told that she did not need an orthotic by her orthopeadic surg so have not seen her again. But I can tell you what I had planned for her.

    Polyprop shell or similar
    slight lateral skive - not much but some to reduce the work required by the Peroneus Longus on the cuboid
    increased lateral column lift - or good lateral longitudinal arch built into the device.
    shoes with increased midfoot stiffness - ie can´t bend the shoe too much under the midtarsal joint.
    icing 2 daily 25 min.

    That was the plan and I have looked for papers on biomechanical tx options but I didn´t find any.

    Note also that I saw this patient many months after problem began, if it was a new presentation then treat as all fractures - Boot etc then after 4-6 weeks look at biomechanical treatment options.

    Hope it helps some
     
  6. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Stress fracture of tarsal cuboid bone in early childhood.
    Joo SY, Jeong C.
    Eur J Orthop Surg Traumatol. 2014 Sep 24.
     
  7. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    A case of cuboid bone stress fracture in a senior high school rugby athlete
    Tetsuo Hagino et al
    Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology; Available online 16 October 2014
     
  8. NewsBot

    NewsBot The Admin that posts the news.

    Articles:
    1
    Cuboid Stress Fractures
    Henry Lau, Mark A. Dreyer
    In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan.
     
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