"Subluxed Cuboid"?

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Hi,

I run a voluntary climbing injury clinic at an indoor climbing wall.

I've got a client who fractured his calcaneum several months ago. He complains he walks on the outside edge of his foot and can't weight bear properly through his big toe. Mobility of the subtalar joint is quite restricted.

Does this sound like it could be a "subluxed cuboid"? It's a a bit beyond me, I'd like to refer him to a Northwest UK based podiatrist with a bit of expertise in the area. Any recommendations.

 

:welcome: to Podiatry arena stemill

With the information you have given the only answer can be no idea.

Wheres the pain?
What important biomechanical finding do you have from an examination ?

Hit us with much more information maybe we can help.

 

Sounds more like post-traumatic restriction of motion of the subtalar joint due to intra-articular calcaneal fracture. Have your patient see a podiatrist or orthopedic surgeon who specializes in foot pathology since this sounds like a potentially complicated case, may require further surgery, and is not likely "cuboid syndrome".

 

Hi there.

The pain is extends from the base of the fibula - where there is some swelling and quite hard scar tissue(?) across to the base of the 4th and fifth meta tarsals.

The subtalar joint seems very stiff. In terms of range of movement the foot has reasonable inversion but very poor eversion, with what the client describes a kind of block after which there can be be some painful clicking and a build up of pain in the dscribed areas sometimes extending along the fifith metarsal.

 

http://www.jssm.org/vol5/n4/18/v5n4-18pdf.pdf

 

Simon posting an article with this...
"Once properly diagnosed, cuboid syndrome responds exceptionally well to conservative treatment involving specific cuboid manipulation techniques"

 

So...? Your point is?

 

Im sorry but I dont understand.... I've never heard of that...and to be honest, the initial symptoms completely baffle me..

Regards

Craig

 

I'm more confused than ever! Is it worth trying the cuboid whip manipulation or could it do more harm than good?

 

No,

A very Big No.

Stemill - 1st you need to work out whats going on - what tissue is stressed. ie a diagnosis

Then you need to work out why is it stressed

Then you can begin treatment.

If it´s beyond your scope of practice I would suggest you refer on.



read that line again - Once properly diagnosed, cuboid syndrome responds exceptionally well to conservative treatment involving specific cuboid manipulation techniques.

Ive highlighted the important point - Once diagnosed.

take a breath. Ask yourself if it is beyond your scope of practice if not then come back with a complete assessment results, medical history, signs and symptoms and I would suggest some X-rays and we can see if we can help.

But please no manipulations yet we have to workout what we are dealing with 1st.

 

To reiterate what Kevin wrote; this sounds like post- traumatic arthritis of the STJ secondary to intra-articular calcaneal fracture.

Forget about the cuboid for now.

Get some imaging organized, and look at this for the potential for STJ fusion.

LL

 

Agreed. I posted the link to that article so that people might be better informed regarding diagnosis and assessment of cuboid subluxation, not so people could start trying to manipulate cuboid's without the required skills and knowledge.

I've read an article on STJ fusion, but I'm not about to start performing them.

 

OK Thanks everyone. I think a sub talar fusion is exactly what he's trying to avoid.

I'll see if i can get some x-rays of him and post them on here.

I think the best thing is to get him to see an expert, any recommendations for NW England? (Merseyside/Cheshire/Lancashire).

 

Try G Flanagan- search members list: G page 1

 

I'm in Lytham St Annes and have access to a full range of imaging and ultrasound facilities. Also climb winter & rock if that helps. 01253 781999

 

Stemill:

With an intra-articular calcaneal fracture, there can be quite a significant loss in range of motion of the subtalar joint (STJ) due to post-traumatic osseous reconfiguration of the three-dimensional structure of the calcaneal joint surfaces of the STJ and/or post-traumatic soft-tissue scarring within the STJ. If significant STJ pronation range of motion is lost due to the calcaneal fracture, then the lateral forefoot will begin to bear significantly more ground reaction force than it did before the calcaneal fracture causing increased stress on the lateral forefoot/lateral column and, over time, resulting in the exact symptoms you have reported so far in your patient.

Unfortunatey, these are some of the most challenging patients to treat conservatively and, as a result, the patient may require surgical intervention. If a health practitioner did a cuboid manipulation on such a patient, without doing a proper diagnostic workup first and trying other conservative therapies to relieve their symptoms, I would consider this a potential act of medical malpractice.

Hope this helps.

 

Sorry Mark, didn't mean to omit you, always think of you being in Scotland... sorry.

 

No worries - we're in the process of a peaceful takeover down here. Hope to raise the saltire on Blackpool Tower this summer!

All the best

 

Stemill, take heed of these very wise words. The black snake whip is a high risk technique even in skilled hands.

Ted.

 

Given it is only a couple of months old, it might still improve. However, a few questions....was the patient casted? did he/she receive any P.T. to mobilize the subtalar joint? Is the fracture intra-articular? Was a C. T. scan run to truly determine the integrity of the subtalar joint? Judging from the fact that the patient is walking on the outside of his foot, sounds like he's trying to splint motion within the subtalar joint. If so, a subtalar arthrodesis may be in the offing.