Members do not see these Ads. Sign Up.

I've seen a few people with a variety of symptoms , some with midfoot pain about the cuneo/navicular area occurring while walking, one with neuroma like symptoms and some with nothing specific other than tired feet wanting a massage.

While assessing various joints about the foot for ranges of motion and where to look to mobilise I find the dorsal aspect of the cuboid to be an uncomfortably painful spot when I attempt to assess or mobilise it.

In some cases it seems to be rock solid and any attempt to mobilise it in a plantar direction is too uncomfortable for the patient.
I presume that the cuboid is stuck.

I read the thread on subluxed cuboid and couldn't really relate the discussion there to what I'm experiencing

Does anyone have any tips on

1/ what might make the dorsum of the cuboid so tender? ( and it's usually just the cuboid)

2/where else the problem might be if it's not with the cuboid

3/ how to mob' or manip' it to free it up with minimal pain to the patient

Thanks
Greg

 

Hi

3/ how to mob' or manip' it to free it up with minimal pain to the patient

apologies for the quick and short reply but I'm just heading out.

If it is a matter of mobilisation then Mulligans Mobilisation with Movement (MWM's) has a cuboid mobilising technique I find simple and easy to use. Importantly, the pt can control the force of application whilst the practitioner applies a grade of sustained pressure. The grade of pressure can be easily varied to make it tolerable to the patient.

 

Dear Greg
IF the bone is crook so are the protecting muscles.
They are: extensor digitorum brevis and peroneal tertius
I have no hesitation in sticking acupuncture needles in here to see if you get the appropriate response.

If you cannot mobilise the cuboid from the AP direction perform a PA manip. I am certain if you google this one will be there, if not let me know and I will post how to do it with a photo.
PA manip is the simplest thing to do and works a treat.
From what you wrote you are describing a subluxed cuboid and they hurt ++
Good luck from a very very wet south coast Day6
Regards
Paul Conneely
www.musmed.com.au

 

Hi Greg,
Determining the cause of site of the symptoms would determine the course of action.
If muscular as Paul has suggested, needles, massage, trigger point tx all can assist but you need to determine why the muscles are overworking; usually because of a subluxed cuboid.

May I suggest specific palpating of the symptomatic site, then asking the patient to actively engage the muscle (EDB and/or PTertuis). A sharp reaction would suggest a trigger point in that muscle.

If no reaction, palate deeper to the capsule or ligament and if moving the cuboid while applying the pressure generates a reaction, probably a trigger point in that structure (capsule, lig or fascia). Trigger point release would be indicated. Again, consider the possible causes; a subluxed cuboid typically contributes to those trigger points developing.

Likely treatment will include a high velocity manipulation of the cuboid. May be 'uncomfortable' for the patient but short term pain for therapeutic gain would be worth it.

Let us know how you get on.

Ted.