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Cuboid syndrome

Discussion in 'Biomechanics, Sports and Foot orthoses' started by Jaimee Brent, Jun 4, 2014.

  1. Jaimee Brent

    Jaimee Brent Active Member


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    Hi,
    I have a patient coming to see me with suspected cuboid syndrome.
    I have treated one or two of these cases myself before using taping, stretching/pt mild manipulations, and orthoses but I know that a cuboid joint manipulation in the clinic can be very benificial.

    I was just wondering if anyone has any advice about this or if there can be any problems with its use? as i do not want to aggravate the area futher at all and have been cautious of using this in the past.

    Thanks

    Jaimee
     
  2. Admin2

    Admin2 Administrator Staff Member

  3. Peter1234

    Peter1234 Active Member

    Hi
    Has the patient had an x-ray?
    I would suggest the cuboid snap, and the posterior talar glide. Have a look on youtube.
    An orthotic should help to hold the lateral column in position more long term.
    I would also suggest some foot exercises and massage to the area if tolerable.
    In Cuboid syndrome check if the cuboid is subluxed dorsally or plantarward.
     
  4. Jaimee Brent

    Jaimee Brent Active Member

    Thank you!
    I did an adjustment and 50% of the pain released.
    I am trialling cuboid pads etc. But the pt is a kick boxer. I have advised him to use pads and low dye taping when doing it in the future but not to do active contact to the site for a month.
    This is the second occurance of a cuboid subluxation for the patient. And it appeared this time w large heamatomas at anterior and posterior laterally to the cuboid.
    I'm concerned that he may have torn stabilising ligaments of the cuboid and that this may become a chronic problem.
    Apart from cuboid pads and orthoses is there any way to stabilise these joints, especially when bare foot (thix is how he kick boxes and does multiple other martial arts for exercise).

    Any ideas?

    Would an inversion taping over the cuboid help?

    Thanks
     
  5. Peter1234

    Peter1234 Active Member

    Hi Jaimee,
    A cuboid pad may help, but I think it's more important to look at his foot type and the way the foot works in relation to the ground. You want to make sure the lateral column of the foot loads earlier in gait. You could add a few degrees valgus to the forefoot, if tolerable to achieve this. Otherwise strengthening the peroneals, tib post, and check for equinus, if present, stretch the calves and perform posterior talar glide, and trigger point therapy to the distal tibia- at the 'medial gutter'
     
  6. Ian Linane

    Ian Linane Well-Known Member

    Hi Jaimee

    Whilst I appreciate he will want a stable base on the supporting limb when kicking I am curious as to how much, if any, of his weight bearing is more forefoot loading and rotating than rear foot? I know nothing of kickboxing but if he does other martial arts the same question applies.
     
  7. Lab Guy

    Lab Guy Well-Known Member

    "This is the second occurance of a cuboid subluxation for the patient. And it appeared this time w large heamatomas at anterior and posterior laterally to the cuboid."

    In your history taking, what caused the hematoma? What would cause enough force to sublux the calcaneal cuboid joint, cause potential ligamentous injury and cause a hematoma to form? Is he constantly doing roundhouse kicks to a heavy and stiff bag or doing jump kicks and landing incorrectly? What exactly was he doing when the force of impact caused his injury?

    Due to the hematoma, prior to any manipulation, I would think about taking radiographs and possibly an MRI to ensure there is not a fracture present. I would suggest being aggressive and put the patient in a BK walking cast to rest the area. Only after I knew that radiographs were negative for a fracture would I try mobilization of the cuboid. I would still want the patient in a BK walking cast for 5-6 weeks to allow soft tissue healing to occur followed by physical therapy.


    Steven
     
  8. Jaimee Brent

    Jaimee Brent Active Member

    when he showed at my clinic 2 days later there was very little signs of the heamatomas
    pt stated that this subluxation occured after repeated kicking into a partners hands. subluxation occured to the foot which had been kicking.
    x-rays have shown a negative for fracture.
    after manipulation +50% of the pain diminished.
    pt has got mild cavoid gait and already has been prescribed prefabricated orthoses and has been advised by me to get custom made ones due to his high medial and notably high lateral longitudinal arch heights.
    however pt still intends to do martial arts bare foot if possible which is my dillema.

    It was difficult to gage his normal gait due to a very notable limp and then compensation on the uninjured foot.
    I would guess that some early HL is present, however ankle mobility was good.
     
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