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Isolated Cuboid-Lateral Cuneiform Coalition: A Rare Cause of Foot Pain

by MASS4D® Prescription Orthotics June 12, 2018

Abstracts

This study focused on the case of a patient, with a rare case of isolated cuboid-lateral cuneiform coalition, who presented severe foot pain and restricted movements.

A 40-year-old woman with a one-year history of left foot pain, felt this pain beginning to intensify while walking. This was six months prior to visiting an elective foot and ankle clinic.

She reported an ability to walk for only 10 minutes continuously before experiencing left foot pain and swelling.

On examination she was noted to have a pes planus deformity in her foot and was thought to be inherently minimising overload in the lateral aspect of her foot.


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A radiograph of the foot and ankle revealed anterior new bone formation with a beak on the anterosuperior surface of the talus.

An ultrasound of the region was reported as showing an unremarkable talotibial joint but a prominent anterior beak on the talus, which can be associated with a subtalar coalition.

The MRI demonstrated coalition of the cuboid and the lateral cuneiform. 

The findings of the MRI suggested that the coalition was cartilaginous in nature (a synchondrosis rather than a syndesmosis or synostosis).

The cuboid-lateral cuneiform coalition was deemed to be the cause of her pain and hindfoot stiffness.

She was managed with an aircast boot to offload the foot and was referred for physiotherapy.

She was also referred for an ultrasound-guided hydrocortisone injection into the area of the pseudoarthrosis.

Three weeks after the procedure, she was found to respond well to the recommended management measures.

She was advised to gradually wean herself off the aircast boot and commence physiotherapy.

She was subsequently discharged from the foot and ankle service with a long-term plan to consider repeated corticosteroid injections or surgical fusion of the cuboid and lateral cuneiform, if the problem persisted.

She remained well, with full mobility and no stiffness in her foot, requiring no ongoing treatment for her coalition.

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References:

  1. Babu, S., Shenoy, R., Mahapatra, P., Amin, A. (2017) Isolated Cuboid-Lateral Cuneiform Coalition. A Rare Cause of Foot Pain. Journal of the American Podiatric Medical Association: November/December 2017, Vol. 107, No. 6, pp. 556-560.

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