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dorsal cuboid-sigmoid ligament injury

Discussion in 'Biomechanics, Sports and Foot orthoses' started by David Smith, Jun 2, 2016.

  1. David Smith

    David Smith Well-Known Member

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    I have a female patient 50 years old who likes running, she presented with a lateral right foot pain that mainly came on at push off. I could see that the exact time the pain started was when the 5th ray dorsiflexed with GRF, if the foot was everted and push of the medial ray then pain was reduced.

    Pain could be elicited by pinching the joint space between cuboid and 5th sigmoid process or by stabilising the cuboid and pushing up on the 5th sigmoid (this was the most painful) plantarflexion or forceful inversion of the forefoot or 5th ray caused no pain but forceful dorsiflexion of the 5th ray did cause pain.

    I suspect tear of the dorsal cuboid - sigmoid ligament

    I tried using a chairside orthosis to pronate the foot and padding to off load the 5th ray at push off but not much reduction in pain. Tried a stiff rocker boot and this relieved pain but she didn't want to wear it on a daily basis.

    Have you come across this injury before (I haven't) and any ideas about treatment?

    I've got some OTC orthoses that are designed for hallux rigidus and have a stiff slightly rockered full length foot plate, this might work to reduce plantarflexion moments about the 5th ray due to GRF.

    Dave Smith

    Attached Files:

  2. efuller

    efuller MVP

    Some thoughts:
    Sigmoid = Styloid?

    Tension, at push off, will be plantar, so maybe not dorsal ligament. If pain is dorsal, there is compression dorsally. ?Boney injury?

    Onset of pain ? twisted ankle? or insidious onset

    One of the most common injuries in that location is avulsion fracture of peroneus brevis tendon. Pain with muscle testing?

    Just some thoughts,

  3. Never come across the injury.

    But perhaps an MRI might be a good start to rule in or out a few yhings
  4. David Smith

    David Smith Well-Known Member

    Yes styloid oops!
    Onset after running 3 weeks ago - she's runs regularly. She's tried resting and not running but the pain has not resolved. Yes I thought P Brevis avulsion but tensioning or stretching the muscle/tendon does not cause pain. Thought it not a compression syndrome because plantarflexing the 5th ray doe snot cause pain unless you simultaneously push up on the met base (so the met base translates vertically)
  5. David Smith

    David Smith Well-Known Member

    yes MRI would be good but its unlikely her GP would refer for such a minor injury when the diagnosis probably wouldn't significantly change the treatment i.e. immobilisation. Might convince her to wear a cam boot tho I suppose.

    cheers Dave
  6. efuller

    efuller MVP

    When the met is dorsiflexed by external forces, the resistance to that dorsiflexion will be tension in the plantar ligaments and compression of the joint surfaces at the dorsal aspect of the joint. I don't understand how the test you describe would rule out dorsal compression problem as plantar flexing the met will tend to separate the dorsal joint surfaces.
  7. Ian Drakard

    Ian Drakard Active Member

    Hi Dave

    When you palpate around the dorsal cuboid, are any of the joint lines more prominent as well as painful on the right compared to left (especially cuboid 5th/4th met jts)?

  8. Geoff Hull Footman

    Geoff Hull Footman Active Member

    my irreverence again you could try a colonoscopy !!! :confused: or maybe outside your scope of practice mmm???:bash:
  9. David Smith

    David Smith Well-Known Member

  10. james clough DPM

    james clough DPM Active Member

    I see this lateral arch pain fairly commonly. This is usually a rotation of the cuboid into inversion as the peroneus longus pulls the cuboid when the foot is not normally stabilized in propulsion through the windlass mechanism. Certain people will be more predisposed to instability based on the anatomic shape of the calcaneocuboid joint. Medial arch supports generally tend to roll the foot to the outside and exacerbate the disorder. I relocate the cuboid by applying an external rotation and dorsal force to the cuboid and plantarflexing the fourth and fifth metatarsals at the same time. Generally there is a pop and an immediate reduction of symptoms. I apply a lateral arch support in most cases after this and leave this on for a few days. It is important to address the instability of the foot in propulsion and make sure the windlass is working properly. This is very gratifying to treat and results in almost immediate and complete reduction of pain.

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