Cuboid Syndrome Runner’s Healing Time

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Runners need to take immediate action when noticing any type of foot problems. Enjoy this article and learn all you need to know about these types of foot issues. If you are unfortunate enough to have any of the symptoms mentioned here then you will be on track to know what appropriate actions you must take.

What Is The Cuboid Syndrome?

It is one of the tarsal bones (seven in number), which are situated on the outer or lateral section of the foot.

  • The cuboid bone is cube-shaped, and has six sides, explaining the origin of its name.
  • Another significant role that the cuboid bone plays is to offer stability to the foot. It also assists in facilitating the right weight distribution in the entire body.
  • Three arches are present in each foot namely; the transverse, the outer, and the inner. The cuboid has some connection with these three to some extent.
  • An arch is basically a curved form of structure that usually transfers and even bears weight.

When weight lands on the arch, it does not only compress it but also assist in moving energy out to all the sides. In every arch, there is a special keystone, and it is mostly at the apex.

This Keystone, which most often takes a form similar to that of a wedge, locks all the bones into the right place just as a wedge does with building materials. It can also be pointed out that the cuboid bone is also the linchpin of the outer arch of the foot.

  • The lateral or outer arch of the foot comprises the cuboid, the calcaneus, and not forgetting the 4th and 5th metatarsals.
  • The cuboid also performs so many functions in the inner arch as well, where it acts as the tibialis posterior.
  • The tibialis posterior is basically the main muscle that is involved in the process of hoisting for the inner arch. It is also the only muscle among all that is connected to the cuboid bone. To add on that, cuboid also appears in the transverse arch but not as its foundation. The transverse arch is mainly lifted whenever the fibularis muscle (which runs the lateral calf) is engaged.
  • The fibularis tendon usually changes the direction at the ankle point, moving forward and a bit down while over the cuboid bone’s sides, and then under it before making a move towards the inner foot.

If you remember a pulley system, then here is another one in the body. The cuboid bone is basically acting as a pulley for the fibularis that plays the role of a rope. With contraction in the fibularis longus, it is pulled up, making the cuboid to roll in and down.

The foot has 26 bones and 33 articulations that are used for movement purposes. Strong foundation at the three main arches brings a robust and vigorous foot.

Without a firm foundation at the major arches, the foot will be ridiculously weak and very unstable. With twenty bones in the foot, there cannot miss a host of problems that come with that high number. Twenty bones basically mean twenty-six possible cases of bone misalignments in the foot. But all these bones must be in place at all the time because if any of them is out of its right position, functionality at the foot might suffer. Therefore it is important to learn how to walk and stand properly to enable those bones to execute their duties well.

fascitis plantar

photo by Flickr

What Are Their Roles?

As stated earlier, the cuboid bone is a multi-faceted bone and it is located exactly between the 4th and 5th metatarsals. These metatarsals lie somewhere between the fourth and fifth toes and the heel bone. These dorsal surfaces are distinct on their own and have specific roles that they play.

Here are some of the roles that they play:

  1. The top section, which is the rough dorsal, is connected to the ligaments. The Ligaments are the fibrous connective tissues that ensure that the joins are properly attached to the foot.
  2. At the front of the foot, there lies the plantar surface. This surface has a very deep groove for the peroneus longus tendon and the plantar ligament.
  3. The sidelong surface, too, has a very deep groove.
  4. The back surface, referred to as the posterior section is very smooth and in a triangular shape. The triangular shape is meant to enable it to form a joint with the front surface.
  5. The front surface, on the other hand, is minuscule and not in a regular triangular shape. It is divided into two various surfaces to make it house the tarsometatarsal joints.
  6. There is also the inner side, which is very wide and has four sides. It also has an oval surface, which performs various roles.

 

The cuboid plays some of the major roles that foot requires for its proper functioning.  It is responsible for ensuring that the foot is stable and the toes are moving in the right manner. The cuboid also ensures that weight is distributed accordingly in addition to offering flexibility across the plantar fascia, which runs along the foot’s sole.

Cuneiforms and Cuboid bones

Cuboid Syndrome

Have you ever thought that there could be some sort of similarities between ballet dancers and athletes?

  • One of the easiest comparisons between the ballet dancers and athletes are the injuries. The two groups can be easily affected by certain injuries that you do not usually get without performing a dance or participating in sport.
  • Let’s take cuboid syndrome as an example. Cuboid syndrome is a form of injury that affects an individual bone in the foot, and it is very common in athletes and ballet dancers.
  • Before you get to know why it is so familiar with the two groups, it is important to what the syndrome really is.
  • Cuboid syndrome is when the cuboid which is one of the five bones making up the midfoot, gets partially dislocated as a result of an ankle sprain, repetitive injury, and acute trauma.
  • You will agree that these are the main injuries that are associated with runners, ballet dancers and even any other sport that involves a movement of that sort.
  • The cuboid is a bone that is charged with the responsibility of providing stabilization in the outer section of the midfoot. It also assists in distributing the weight of the body so that you can be able to walk, run or do any movement in the right manner.
  • The condition is also popularly known as cuboid fault syndrome, cuboid subluxation, blocked cuboid, dropped cuboid, and lateral plantar neuritis.
  • During running or walking, the muscles of the lower leg go under particular movements that bring the contraction of muscles such as peroneus longus. This form of contraction causes stress on the small bones that are in the midfoot and the surrounding tissues, particularly the cuboid bone.
  • Whenever these forces become too much and beyond the limit that the cuboid bone can be able to control, a tear in one of the affected tissues happens, and this may bring an unusual alignment of the cuboid bone that may cause subluxation.

 

Causes Of Cuboid Syndrome

Repetitive movements of the lower leg muscles: when there is a repetitive contraction of the muscles of the lower leg, extra stress can be placed on the soft tissues that hold the cuboid bone in its right position. This may cause it to tear and therefore resulting in a bone subluxation.

  • Sprained Ankle – Dropped cuboid can also occur as a consequence of an ankle sprain. The most common one is the inversion sprain of the ankle where the foot and ankle turn inward excessively.
  • Severe Injuries. Besides the sprained ankle, other various foot injuries that happen in the middle section of the foot may bring a tear to the connective tissues and therefore bring a fault in the cuboid.
  • Running And Dancing – Dancing moves that are done in repetitive manners especially the belle dancing can cause this condition since it exerts more pressure on the foot.
  • You can also develop altered biometrics as a result of running barefoot and lead to an aching and dull pain in the middle area of the foot.

Image from page 405 of "International record of medicine" (1865)

 

Photo by Flickr

Symptoms

The symptoms of this condition may include the following:

  1. Chronic or acute aching pain on the foot’s outer section – The lateral part of the foot becomes red and swollen and very tender to the touch.
  2. Difficulties when walking – The pain would increase whenever the patient walks or exerts pressure on the foot. After complete rest, the pain would come down.
  3. The midfoot will become painful or uncomfortable – In most cases, the patient will experience pain whenever they try to hop on one foot.
  4. They may also encounter some form of a decrease in motion, and the ankle movements will be very painful, particularly inversion.

Just as indicated above, unless you are a professional in medical services, some of these symptoms could be at times related to various forms of foot injuries.

PRICE-FIRST AID

P. R. I. C. E is recommended by the doctor as a quick first aid after the injury happens. It is an easy and simple protocol to follow in order to help the patient, as soon as possible, but it can also be followed within 24 to 72 hours from the moment in which the injury occurred.

P- Protection
It is better to prevent an injury than to treat it. An injured foot can be protected from a further injury while speeding the healing process by limiting the amount of weight it bears while using the other foot or a cane or a stick for support. The foot can be held still by using braces, tape, and pads, slings or splints. Avoiding to walk on rough surfaces, avoiding complex exercises and low-quality shoes are all great ways to protect your foot.

R-Rest
Rest is a key factor in the healing process. Just like the previous factor, resting prevents the injury from getting worse. You should maintain a relatively high level of activity while avoiding putting pressure or straining the affected area. Restricting activity level can be counterproductive, slowing down the healing rate. Easy gentle movement, such as contractions of the joints and muscles without any kind of pain, can stimulate the body to recover.

I-Ice
The healing process can be speeded up with the help of cryotherapy, meaning ice therapy. Cold treatments can be used to soothe the swollen area and to reduce pain. This therapy is easy and simple and anyone can do it at home. A plastic bag with ice wrapped in a towel is what experts recommend. Avoid placing the ice directly on the skin, otherwise, you might get an irritation, an allergy, or develop skin sensitivity. If your skin gets red, mottled, raised wherever the ice was placed, it means that you let the ice sit for too long and that you should interrupt the cryotherapy. Ice should be applied to the injured area every 2 hours for about 10 to 15 minutes.

C- Compression
Compressing the affected area by using an elastic bandage, tape, or compression wraps can reduce swelling and inflammation, therefore, improve healing. The bandage should be applied properly in order to work: starting from the area above the injury, the bandage should be wrapped around the affected area and around the foot. The bandage should be tight but not too much, otherwise, it can reduce circulation in the area and cause pain, bruises, additional swelling, numbness, tingling. Experts say that the bandage should be loosened up while sleeping.

E- Elevation
Elevating the leg and the foot can reduce swelling and can help the fluid in the area to not accumulate. It helps to heal and to reduce pain. The best way to elevate your leg is to place it at a level above the heart. Experts say that elevation should be accomplished as soon as possible after the injury has occurred, especially while sleeping.

The best way to combine Rest, Ice, Compression, Elevation is to wrap ice around the affected area while elevating the leg and sitting comfortably on the bed or armchair.

The Diagnosis Of Cuboid Syndrome

Out of all, it is not easy to diagnose the cuboid syndrome. The symptoms, as mentioned earlier, appears similar to symptoms of most foot injuries. It is therefore important to see a podiatrist when you experience any of these symptoms. A podiatrist is a special doctor who mainly specializes in the foot and its injuries. This is the expert that a regular doctor should refer you to.

In the case of a subluxated cubic bone, diagnosing with the help of X-rays, MRIs, or CT scans can be difficult because these techniques are not appropriate for the identification of this type of injury. The result is an incorrect diagnosis and a treatment that will probably fail in curing the cubic bone. To be able to diagnose someone with the Cuboid bone syndrome, other conditions have to be ruled out.

To diagnose this condition, the podiatrist will inquire about your physical activities and past injuries to the ankle and the area of the foot. Cuboid syndrome is mostly diagnosed through physical exams, but imaging tests like x-rays may be applied. These are the diagnosis.

Midtarsal Adduction Test

This mainly includes stabilizing the ankle joint using the right hand. The podiatrist will take their left hand, and then lift the foot around the midpoint area and move it towards the other foot, inwardly.  This is done so that the patient’s calcaneocuboid joint is compressed and cause the cuboid syndrome’s symptoms.

Metatarsal Supination Test

In this case, the podiatrist stabilizes the ankle joint while at the same time manipulating the foot in an approximately half circle. This motion is meant to cause the pain of the cuboid syndrome. After these two most important tests, if the diagnosis comes out as the cuboid syndrome, it is important to begin the treatment immediately.  Remember that a cuboid syndrome can be considered if pain fails to subside for a period exceeding three months after an inversion ankle sprain.

Treatment Of Cuboid Syndrome

Once a cuboid syndrome has been diagnosed, the next stage is to treat it. A podiatrist will often recommend either one or two courses of action that will assist you in getting back to your feet.

Relocation

This is the first step in treating this condition and possibly the most painful. The procedure here should only be done by a medical professional. It includes relocating the dislocated cuboid bone to its right position. The process is done in a thrust motion and may at certain points hurt. After the relocation process, the patient is then free to move to next step of supportive treatment that will ensure that the area heals well.

Image from page 813 of "A treatise on orthopedic surgery" (1910)

 

Photo by Flickr

Rest

Rest is imperative for most pull and strains. It can provide the tissue that is around the cuboid bone time to adequately heal. For a particular period, patients should stay off the affected foot as much as they can to facilitate faster healing. At this point, crutches and wheelchairs can be used to assist in keeping the weight off the foot if total bed rest is not possible.

 Immobilization

To immobilize the ankle, the healthcare provider will tape, pad, and even use compression bandages for faster healing. The padding can assist in lowering chances of another injury.

Cold Compress

It is also known as an ice pack, and it can also assist in reducing pain and swelling in the injured foot. The ice pack should be mostly applied five to six minutes at a time, and three times in one day.

Orthotics

Orthotics offers support to the foot and can be comfortably worn inside a shoe. It assists in the foot’s proper alignment and also reduces the foot’s overpronation.

Exercises

When the injuries are at their acute phase, no exercises should be practiced. This is done to avoid the inflammation of soft tissues and the aggravation. But you should resume the exercises once the healing process has begun and the pain has reduced. Balance exercises should not be ignored since that would place the patient at a risk of further ankle and foot injuries in the future. Pain-free movement and strengthening exercises should be undertaken daily to prevent the foot from getting stiff and weak.

If a faster treatment is initiated after a cuboid subluxation condition has been detected, the foot’s full functions will be restored immediately. Here are some of the facts that you should also know about the cuboid syndrome. 80 percent of those suffering the cuboid subluxation condition have overpronated feet.

4 percent of foot injuries in athletes and 17 percent of ballet dancers are caused by the cuboid syndrome. The cuboid bone rotates at an estimated 25 degrees when turning the foot outwards and inwards.

About 7 percent of ankle inversion sprain patients also suffer from blocked cuboid.

 

NAN XUONG VE VI TRI CU - CUBOID BONE FRACTURE

 

 

Photo by Flickr

Exercises for the cubic  syndrome

1.Reclined Hero’s pose
This move is very relaxing and stretches the glutes, the triceps, and the core. It is great for ankle flexibility. It does not require any kind of equipment, except an optional mat.
– Start on your knees, on your mat. Your knees should be apart from each other and your lower legs to the sides.
– Slowly lay on your back, using your arms and first laying on your elbows and then on your back. At this point, your buttocks should make contact with your mat and so should your back and your shoulders. Your lower legs should make contact with the upper legs, but you shouldn’t sit on them.
– You can also bring your arms, near your head, your biceps should touch the sides of your head and the forearms should be placed near the top of your head. Breathe and close your eyes for a moment. Try to relax and feel the stretch in your muscles.
– When you feel satisfied, lift yourself back to the initial position, by using your forearms. You can repeat the movement a couple of times.

2. Legs up the wall
This is perhaps the most simple move, but it is very effective. It doesn’t require any kind of equipment, only an optional mat, and a wall.
-Start on your back, facing a wall. If you don’t have a wall near you (ex. You are in a parc) you can start by sitting on the mat with your legs straight in front of you.
– Lift your legs up the wall, your heels should be the ones to touch the wall, but the closer you are with your legs to the wall, the more you’re going to feel the stretch. If you don’t have a wall, you can try and reach your toes with your arms, while bending at the waist.
– You can now move your feet by pointing and rolling your heels to the wall. If you don’t have a wall, you can still do this. Don’t forget to breathe. Relax, close your eyes and feel the stretch.
– Come back to the initial position.
– Repeat this move a couple times until you feel satisfied.

3.Down dog foot pedal
This move is perfect for the legs, feet, back, and arms. It is a yoga move, but it can be used as a stretch move. It does not require any kind of equipment, except an optional mat.
– Start on all fours, with your hands on the mat, beneath your shoulders and your knees beneath your hip joints a bit apart. If you have problems with your wrists, you can start by placing your fists on the mat with your knuckles facing the ground.
– Slowly lift your knees from the mat using your legs. You should resemble a boomerang with your legs and arms straight. Breathe throughout the whole exercise.
– Start pedaling while bending and straightening each knee at a time. Don’t forget to exhale and inhale every time you need to. Feel the stretch and do every little movement with awareness.
– Slowly come back to the initial position and take a quick break. Repeat a couple of times until you feel satisfied.

4. Revolved single-leg forward fold variation
This is a great move for stretching and flexibility. It targets the glutes, the calves, and the feet. You don’t need any kind of equipment, just an optional mat.
– Start by standing tall with your feet together.
– Cross your legs so that the right foot is on the left side and the left foot is on the right side. If you are not very flexible, you can just cross them slightly or not at all.
– Bend at the waist and reach the ground with your hands. If you are not very flexible you can just lower yourself and reach your knees.
– Breathe and feel the stretch in your muscles.
– When you feel satisfied slowly come back to the initial position.
– Repeat on the other side, for example, if you first had your left leg over the other it is now the time to do the same exact movement with the right leg over the left one.
-Repeat a couple of times until you feel satisfied.

5. Heron pose
This movement is really great for stretching the glutes of one leg and the hamstrings of the other. It is quite simple and does not require any kind of equipment, just an optional mat.
– Start on your knees, while sitting with your buttocks on your calves.
-Slowly bring one leg in front of you then bend it at the knee. Slowly straighten your leg and hold your foot with the help of your hands. You can play with your foot by pointing your toes or drawing an “O” with your toes clockwise and in reverse. The closer your leg will be the more you’re gonna feel the stretch.
– Keep this position and don’t forget to breathe. Hold this until you feel satisfied.
– Come back to your initial position and repeat on the other side.

6. Bound angle pose with feet massage
This movement is perfect for stretching your inner thighs, your back, and feet. All you need for this is an optional mat.
– Start by sitting on your mat, on your buttocks.
– Bend your legs and bring your knees to the sides, while bringing the soles of your feet together.
– Bend forward, at the waist and massage your the soles of your feet. Don’t forget to breathe and relax.
– Come back to your initial position, take a little break and repeat until you feel satisfied.

7. Supported bridge variation
This is great move to stretch your hamstrings, your feet, and your core. For this move, you’ ll need a mat and an optional block to support you.
– Start by laying on your back, on your mat.
– Bend your legs at the knees and lift your pelvis towards the ceiling. Leave your shoulders on the mat and don’ t forget to breathe.
– Place the block under you, near your lower back. If you don’t have one, you can omit it or just use a pillow.
– Send one of your legs underneath you, while keeping your position and your toes pointed.
– Breathe and hold your position, feel the hamstring and your shins stretch.
– Bring the sole of your foot back to the ground and come back to your initial position.
– Repeat the move with the other leg.

8. Reclined cow face pose
This is a great stretch for the outer thighs, feet, and the upper glutes. All you need is a mat.
– Start on your back, on the mat.
– Bring your knees close to you and then cross your legs. Hold your feet with your hands and slightly pull each leg to the side and feel the stretch. Hold this position until you feel satisfied.
– Come back to your initial position and take a break.
– Repeat on the other side, for example, if you first had your left leg over the other it is now the time to do the same exact movement with the right leg over the left one.
-Repeat a couple of times until you feel satisfied.

9. Walking barefoot
This is a great exercise that does not require any equipment, specifically not shoes and socks. Take your shoes and socks off and get walking. Try to walk on smooth surfaces, in your home, and on the grass if you might enjoy a good walk.

10. Reverse tortoise
This move is one of the most simple moves. It does not require special equipment, just a regular mat or just a blanket.
-Start by laying on your back, on your mat.
-Bring your legs to your chest by bending your knees.
-Play with your toes while you inhale and exhale.
– Keep this position until you feel satisfied then come back to the initial position.
-Repeat until you feel satisfied.

11. Toe stretches
This is a move that does not require a lot of range motion or equipment.
– Barefoot, step forward and try to transfer your body weight on a leg, then on the other
– Breathe while you do this and keep doing it as long as you feel comfortable
– Repeat until you feel satisfied.

12. Hands to toes
This is a great move for stretching the toes while using your hands. All you need is a mat or a blanket.
– Start by sitting on the floor. Be relaxed and keep a breathing pattern
– Bring the left foot on the right thigh
– Interlace the fingers of your right hand with the toes of your left foot
– Keep playing with your fingers and toes moving them back and forth.
– Come back to the initial position take a break then repeat on the other side
– Repeat this move as much as you need.

CUBOID BONE PAIN

Cuboid bone pain is mainly experienced in two areas, the outside part of the foot and the inside part of the foot.

The Outside Foot Pain

  • Pain on the outer side of the foot or the outer foot pain is known as the lateral foot pain. This condition may come on gradually making the patients complain of a sore on the outer side of the foot.
  • The cuboid bone is located laterally, and the structures of ligaments associated to it can bring pain in this area from direct trauma or overuse. That is why it is referred to as cuboid bone pain.
  • The sudden onset pain on the foot’s outer section can be originating from a fracture of the fifth metatarsal. Injuries to this particular bone are very common in the sports fields.

 

Causes Of Cuboid Bone Pain

  1. A) The Outside Section Of The Foot
  • Peroneus Brevis tendon injury – A rupture or strain of this tendon can happen at the insertion point.
  • Midtarsal joint sprain
  • Jones fracture, which is a fracture of the fifth metatarsal bone near the ankle
  • Heel pain, and
  • Forefoot pain
  1. B) Gradual Onset Cuboid Bone Pain

This is pain that comes on gradually. In most cases, the athlete is usually unable to point out the exact time when the injury occurred. Here are the common causes of the gradual cuboid bone pain:

  • The navicular fracture – This is a leading stress fracture that mostly affects sportspeople, particularly those in explosive events like jumping and sprinting.
  • Extensor tendonitis
  • Tibialis posterior tendinopathy
  • Mortons neuroma
  • Metatarsal fracture
  1. c) Midfoot pain
  2. d) Forefoot pain

 

CUBOID FRACTURE

Fractures of the cuboid can take in isolation but are mostly associated with other types of fractures and dislocation of the midfoot. These fractures can occur through mechanisms that could be either direct or indirect.

Mechanism of the cuboid fracture may include the following:

  • Minor fragmental avulsion fractures, which occur at capsules and ligament insertions. These are the most common types of cuboid fracture.
  • Direct trauma: the isolated body fractures are very uncommon and usually as a result of a direct trauma.
  • Indirect trauma: there is a specific injury pattern that has been widely referred to as the nutcracker fracture. This type of fracture occurs as a result of an indirect compression force where the cuboid is crushed somewhere between the fourth and fifth metatarsal and the calcaneum. It is caused by axial, torsional forces that are applied to the plantar-flexed foot.

The cuboid is the anatomical title that is given to the bone of the midfoot and is situated at the outer side of the midfoot just in front of the ankle. There are so many muscles in the foot and the lower leg that attach to the cuboid bone. When there is a contraction in any of these muscles, a pulling force is then exerted on the bone.

When these forces become too repetitive or excessive, and beyond what the bone can tolerate, bony injuries and damage can then occur. It then causes what is typically referred to as bony stress reaction, which can progress later as a cuboid fracture.

More commonly cuboid fractures are mostly occurring in conjunction with a host of other complex foot injuries.

It is also paramount to note that injuries to the cuboid may astute and may at times be wrongly diagnosed as lateral ankle sprains. The isolated fractures of the cuboid are very uncommon and can be very hard to diagnose. They are most commonly part of the complex injuries that may include the fracture dislocation of the midfoot.

Image from page 85 of "Minor surgery, or, Hints on the every-day duties of the surgeon" (1843)

Photo by Flickr

Causes Of A Cuboid Fracture

Just like other types of fractures, there are two main causes of a cuboid fracture. They include the following:

  • Stress
  • Trauma

Symptoms & The Presentation Of Cuboid Fractures

  • The common symptoms of a cuboid fracture include the following:
  • Localized tenderness and bruising
  • Instability or pain during weight-bearing activities
  • The pain would mainly increase with an increase in the levels of the activity
  • Pain when holding the outer section of the foot firmly
  • Pain may also radiate to the heel, toes, or the sole

A fracture of the cuboid mostly occurs as a result of too much weight bearing activities. The activities may include dancing, running, jumping or sprinting. They mostly occur following an increase in an activity or a change of the conditions of training that may include changes in technique, footwear, or the surfaces.

Fractures of the cuboid can present with varying deformity and swelling of the lateral part of the midfoot. Ecchymosis and swelling over the cuboid should be handled carefully in this case. When there are other midfoot injuries present, then a thorough inspection of the cuboid articulations should be carried out for any form of astute injury.

In most cases, there is a right tenderness to palpation over the cuboid and particular difficulty with weight-bearing exercises. The dislocation of cuboid has been reported to happen in close to 10 percent of high-performing athletes, and 17 percent of ballet dancers. This condition presents a pain in the lateral section of the foot, which radiates all the way to the ankle and the outer metatarsals bringing in the sense of weakness in plantarflexion especially during push offs.

Just as traumatic injuries, cuboid fractures are related to some extent to the repetitive forced abduction that usually happens at the forefoot.  However, the diagnosis could appear a bit different especially with active athletes. The fractures could present with chronic lateral foot pain.

Diagnosis

  • To diagnose a cuboid fracture, AP, lateral, and oblique views are just enough. However, oblique medical views performed by a certified medical practitioner may work better for a patient with this condition.
  • What follows after the identification of the cuboid fracture is the weight bearing views that are also supposed to be obtained to determine whether there are more injuries especially on the ligaments.
  • Despite the fact that a proper objective and subjective examination from a physiotherapist may be just sufficient to diagnose this condition, there are further measures that could be undertaken.
  • To confirm the diagnosis and determine the injury’s severity, X-ray, CT Scan, MRI or bone scan may also be imperative.

 

Prognosis Of A Cuboid Fracture

With the right physiotherapy management, patients who suffer from this condition can have a total recovery and return to their sports in a period that ranges from three to six months. In more serious cases, recovery may even take up to one whole year, or even longer, based on the intervention needed and a variety of other vital factors.

In other rare instances, patients may continue experiencing continuing symptoms and other complications that may need further management measures.

Treatment For A Cuboid Fracture

Treatment of a cuboid fracture begins with a period that is dedicated to rest. The patient is supposed to take some time off from weight-bearing activities.

  • The initial phase could also include immobilization in a plaster during these periods of non-weight bearing. Patients can also be advised to use protective boots and crutches for a period. As a result of this, a slow rise and improvement in exercises and weight bearing activities may begin as tolerated, as long as the symptoms do not appear stronger again.
  • This first process of treatment should be undertaken for several weeks to months, following directions from a qualified physiotherapist. The instructions given by the physician will vary depending on the injury’s severity.
  • Patients should be very careful not to adopt a ‘no pain, no gain’ attitude as this may cause further damages. They should also not ignore the symptoms as this will not only cause further injuries but also slow the process of healing. To ensure a speedy process of recovery, an appropriate treatment is very important.
  • There are also various forms of manuals ‘hands-on’ therapy that are usually administered by a qualified physiotherapist.

They may include trigger point release techniques,

These techniques can also play a role in ensuring that the condition is managed.   Apart from speeding the healing process, these techniques can also improve the range of movements and functionality of the body. They can also correct the factors that contribute in one way or another to the development of the condition.

  • Administering the mentioned techniques can begin once an indication from a physiotherapist confirming that the process is safe has been obtained.
  • Patients are also advised to perform pain-free strengthening and flexibility exercises as part of the rehabilitation process.
  • These exercises should, however, be done immediately after the first phase of the recovery process.
  • It is only through this that an optimal outcome can be achieved. There are also a variety of other activities that can also be done to maintain body fitness.
  • These activities may include swimming, water running or cycling. It is the work of the physiotherapist to advise which activities are suitable for the patient and the right time they should be performed.
  • In the last phase of rehabilitation for a cuboid fracture, a slow return to normal activities or sports can be allowed as per the instructions of the treating physiotherapist.

However, these conditions are only safe if they would not lower the healing process and maybe increase the symptoms. It may begin with an unhurried return to the running activity that would recondition the cuboid to participating in a regular and efficient running.  Appropriate footwear or the use of orthotics may also be recommended for the patients. The orthotics are very essential to those patients whose lower limbs biomechanics might have contributed to the development of the condition.  To ensure that the condition does not occur again in the future, proper training methods and techniques must be initiated.

Dealing with the pain

Whether you are recovering from a surgery, or you’ve just applied the P.R.I.C.E procedure, you might want to reduce the pain. Here is a guide to painkillers and other drugs that reduce the pain well.
Mild pain
If you have mild pain, you can get painkillers such as non-steroidal anti-inflammatory drugs (NSAIDs) such as paracetamol or ibuprofen can be found at any supermarket, pharmacy, or from your doctor. It is better to have a prescription from your doctor, specifically if you have allergies to some kinds of substances, but usually, you can just read the leaflet or ask your pharmacist.

Paracetamol
Paracetamol is one of the most common pain relievers that can be found in many stores. It is sold in the form of tablets(dissolvable and non-dissolvable) and capsules. Take one tablet every five hours and don’t take more than eight capsules in 24 hours. Taking more than the recommended dose can damage your vital organs, specifically the liver. Don’t take these pills if you have liver problems and didn’t talk to your doctor.

Non-steroidal anti-inflammatory drugs (NSAIDs)
Non-steroidal anti-inflammatory drugs (NSAIDs) are also a group of painkillers you can get without prescription such as ibuprofen, naproxen, which are found in the form of capsules, tablets, and also creams and gels. This kind of drugs can relieve the pain and help reduce the inflammation. You should visit your doctor or ask your pharmacist, specifically if you have asthma, heart problems, kidney problems because they can affect you. Doctors say that this kind of painkillers need to be taken after a good and nutritious meal because they can cause ulcerations and irritations on the lining of the stomach. Taking these pills should be a temporary treatment for the pain, if the pain becomes more and more severe then you should talk to your doctor.

Moderate pain
If your pain becomes stronger, then you can take some painkillers that include Tramadol, dihydrocodeine, and codeine.
Some of these can be combined with paracetamol in order to become more effective. These kinds of painkillers, such as Co-codamol, Co-dydramol, and Tramacet can be found in pharmacies, but they usually cannot be sold without a prescription. They can be sold in the form of tablets, skin patches, such as BuTrans Patches, that contain buprenorphine.
When codeine meets paracetamol, Co-codamol is created. It can be found in different amounts, some pills have more and some less. The ones that can be sold without prescription have very little of it, while the strongest ones need a prescription from your doctor who will also help you decide the right amount for you. The best thing you can do while using this medication is to check the medications that interfere with it such as NSAIDs and check the ones that also have paracetamol in them so you won’t take too much paracetamol.
The BuTrans patches are easy to find but available with a prescription. Although it might seem like just a patch, it contains an active substance that penetrates your skin while reducing the pain. You can use it an entire week and it does not keep you away from activities such as swimming, showering, and bathing. The only thing you have to do is to apply it to your skin somewhere clean, hair-free and on the upper body. Keep away from heat!!! Heat can help your skin absorb too much of the medicine. At the end of the week, you can replace it with a new one that you can apply so where else. If needed, NSAIDs can be used for additional pain relief, but check-in with your doctor first.

Severe pain
At this point, checking in with your doctor should be a priority on your list. He will help you decide what kind of painkiller you should take and how much.

Morphine
When the pain is severe, you need to take a pain relieving medication that is quite strong such as morphine or derivates.
Morphine medications, in the form of tablets, patches, and liquid preparations, can be useful in releasing the pain. The results start showing after some time and then the doctor might prescribe something lighter such as a codeine-based medicine to see either there has been any pain improvement. Paracetamol or NSAIDs can be taken if needed, only with the doctor’s approval.

Antidepressants and antiepileptic drugs
Antidepressants and antiepileptic drugs can help when the pain is severe. The first ones help by changing the amounts of certain hormones in your body specifically those that cause pain, while the second ones block the transmission of pain signals.

Some of these drugs can cause severe addiction!

Diet

The key to a good recovery is a good lifestyle and a big part of that is the diet. A healthy body heals faster than an unhealthy one. Here you have a list of fundamental and vital components your body needs to function properly and to heal.

Calcium
High calcium foods are very important for your bones since your bones are made of mostly calcium.
Calcium is very important for the repairing process of your bones. It can be found in your bones. You can help your body heal by eating more calcium-rich foods. Sea vegetables and green leafy foods, such as spinach, kale, broccoli, salad, algae, are full of calcium.

Vitamin K
Vitamin K can be found in kale, broccoli, greens, tomatoes, spinach, avocados, rye bread, cauliflower and brussels sprouts.
It is really important for the blood and for the bones. Vitamin K is quite important because it enhances the absorption of calcium and other nutrients. It helps the reconstruction and repairing of existing cells.
Prevents excessive bleeding.

Protein
Many people think that protein can be found only in animal products, but that is not true. Animal products are acidic, they are an impediment to the healing process, therefore experts suggest to get protein from more fresh and alkaline foods such as soybeans, red kidney beans, corn, hemp seeds, sunflower seeds, flax seed, chickpeas, pumpkin seeds, sesame seeds, walnuts, hazelnuts, fruits such as mangoes, bananas, and cereals such as barley, wheat and so on.
Protein is important for the reconstruction of cells and for the soft tissues.

Vitamin C
Collagen, which is very important for the soft tissues, is produced only if the Vitamin c intake is enough.
Vitamin C is very important for the immune system because it helps the body fight against colds, the flu and numerous illnesses that are infectious. It helps the body absorb calcium, therefore it contributes to bone healing. It also contributes to strengthening the muscles and to build the cells of tissues.
Eat citrus fruits, such as lemons, mandarins, and oranges, red bell peppers, strawberries, tomatoes, parsley, green peas, mangoes, spinach and dandelion greens, Brussel sprouts, red berries, and blackberries.

Lysine
Lysine is a very important amino acid for the synthesis of the proteins and for the metabolism, therefore it is fundamental in the reconstruction of cells, including the cells of the bones. It helps the muscles, ligaments, and bones repair and eventually grows and it is necessary for the absorption of calcium. It is found in chickpeas, lentils, soy, lima beans.

Zinc
Zinc is a key component for the reconstruction of the bones and you can find it in seeds, spinach, and tropical fruits.

AVOID THESE FOODS AND SUBSTANCES
-Salt (too much salt changes the alkaline balance in the body resulting in bone loss from calcium deficiency)
-Caffeine (too much caffeine changes the alkaline balance in the body resulting in bone loss from calcium deficiency)
-Alcohol (increases inflammation and bone mass loss)
– Sweetened beverages (increase the bone mass loss)
– Refined products (have a low content of useful nutrients and remove the calcium in the bones)

Contributing Factors To The Development Of Cuboid Fracture

There are various factors why may promote the development of cuboid fracture. These factors should be identified and corrected immediately with guidelines from the physiotherapist. They include the following:

  • Inappropriate footwear
  • Poor foot posture, particularly the high arches or flat feet
  • Muscle weakness especially of the quadriceps, gluteal, core, and calf stabilizers
  • Joint stiffness, mostly at the foot or ankle
  • Poor flexibility of the peroneals and calf
  • Inadequate diet
  • Poor running technique
  • Excessive trainings
  • Inappropriate training techniques especially on uneven and hard surfaces

 

Exercises For A Cuboid Fracture

These are the exercises that are mostly recommended to patients suffering the cuboid fracture. Before beginning these exercises, the patient and the physiotherapist should sit down and discuss the suitability of these exercises. They are supposed to be performed three times in a day. But you shouldn’t begin until the physiotherapist indicates that the process is safe.

Foot and Ankle Up & Down – move your ankle and foot up and down as comfortable as you can. You can repeat it ten to twenty times as long as you do not experience any pain.

Foot And Ankle In & Out – move your ankle and foot in and out as comfortable as you can. This process can be repeated for more than ten times as long as it feels safe.

Conclusion

The cuboid syndrome, which occurs in the cuboid bone, is a relatively common and painful condition that inflicts the lateral midfoot. This condition can be hard to identify since there are no definitive diagnostic procedures. The diagnosis of this condition is mostly based on a constellation of signs and symptoms as well as a high index of suspicion. The manipulation of the cuboid should be regarded as the first treatment of cuboid syndrome unless contraindicated.

It is important to note that the medical conditions mentioned in this article can get quite severe and therefore the patients should seek professional healthcare from physiotherapists or a qualified podiatrist.

To provide a backup for the health claims made in this article, the following sources have been utilized. They are reliable sources extracted from health and scientific study topics done by professional medical connoisseurs.

Co-written by Edy Mihai

Curated by Diana Rangaves, PharmD, RPh

Sources

  1. Staff Writer, Cuboid Fracture, Health Line, May 18, 2017
  2. Staff Writer, Cuboid Bone, Med Help, May 18, 2017
  3. Staff Writer, Cuboid Bone, US National Library of Medicine National Institutes of Health , May 18, 2017
  4. Staff Writer, Foot Surgery, AOFAS, May 18, 2017
  5. Staff Writer, Home Remedies Cuboid Syndrome, My Health, May 18, 2017
  6. FItzgordon, Jonathan, The Cuboid Bone, Core Walking, May 18, 2017
  7. Staff Writer, Cuboid Syndrome, Pain Care, May 17, 2017
  8. Staff Writer, Cuboid Bone Fracture, Auto Accident.com, May 16, 2017
  9. Staff Writer, Cuboid Syndrome, Foot Pain Explores, May 17, 2017
  10. Staff Writer, Cuboid Bone, Health Line, May 18, 2017