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I have a pt who has MS.
She has a severe pain, present while walking, on the dorso-lateral aspect of her left foot near the EDB area with heat and swelling. There is no pain elicited on resisted movement.
There is a large hard lump on the ?cuboid. No pain can be elicited from movement of any joints in any direction.
The only pain is on palpation of the swelling at and around the area.
I have ordered x-rays to see the position of the cuboid in relation to other bones, and I have suggested blood pooling to see the extent of inflammation.
Does anyone have any suggestions as to what it might be?
Do you need any more info to have a better idea of whats going on?
Many thanks to any and all who can help
Mahtay

 

Best guess is some sort of partial dislocation from muscle weakness.

 

Thanks Craig, I thought the same. She has what some surgeons call flexor substitution-very flat and straight, almost dorsiflexed 2-4 toes. There is toe walking and late pronation present.
I have padded the heels with PPT (R>L) to try and change the dynamics between the Calcaneus and the Cuboid.
Any other things anyone can suggest?

 

Maybe an AFO can help her or a firm well supported shoe.

 

Most common disorder of this type is called "cuboid syndrome". Treatment consists of applying 1/4" beveled felt trapazoid, (or mid-met pad), to plantar foot, (extends from distal 1/3rd of mets to just anterior heel), with Campell's strap. Condition arises from jamming of dorsal calcaneal-cuboid joint on propulsion of (loose) pronated foot. The pad stabilizes the joint. Relief is usually immediate. This assumes "lump" is really inflammation. If not successful, aspiration or biopsy of lump may be indicated. Sonography may be most helpful. Dislocation would be quite rare, following trauma, and would be accompanied ecchymosis. Hope this is helpful.

 

The cuboid is displaced dorsally, not plantarly as in usually presented cuboid syndrome.
But I will try an AFO-these things might work yet!
thanks!!!
Mahtay

 

Correct me if Iam in error,but isn't cuboid syndrome mostly a sports medicine condition-dancers,for example.Why I asked this is because(and this may not be the case either) the patient has MS,so I do not think she is all that active.

 

She is not very active, she is just fighting to keep her independence; but by walking on her anterior foot with major heel lift, the rearfoot is hyper-hypermobile.
I forgot to add that I suggested a good old off the shelf elastic ankle brace. She reported back that she used this and the effect was immediate and marked.
I assume it gave the surrounding soft tissues a rest. If she deteriorates later on I will upgrade to and AFO I think.
Cheers
Mahtay

 

hey mahtay

have you got the xrays back yet?? if so what did they show re-cuboid position

interesting case!!!

cheers

claire

 

Yes I got the X-Rays back and they showed some of the loveliest joints in town!!!
Some Sub-chondral sclerosis but no obvious subluxation.
Mahtaciosness