Cuboid Syndrome | Chronic Lateral Ankle Pain Assessment & Treatment

Ankle sprains account for a big portion of lower extremity injuries with up to 40% of cases having residual symptoms. There’s a hypothesis that the cuboid may be responsible for those cases in which lateral ankle pain persists. It appears that the condition has a higher prevalence in professional ballet dancers. The hypothesis for cuboid syndrome is based on history clusters of signs and symptoms, differential diagnosis, clinical expertise, and of course mechanism of injury. It’s assumed that during a severe initial inversion trauma, torsion between the cuboid and navicular bone and cuneiform as well as the calcaneus leaves the cuboid in a relatively supinated position.

Denne disposition forbliver smertefuld specifikt over calcaneocuboid-leddet, mens ømhed over laterale ankelbånd aftager. Patienterne udviser en antalgisk gang med øget smerte i afsætsfasen, og hvis smerten tillader en mobilitetstest, er der ikke noget ledspil. En teknik, der er beskrevet i litteraturen, er repositionsmanipulation til relativ pronation.

Det rapporteres, at patienterne efter manipulationen var smertefri den følgende dag og kunne vende tilbage til deres aktiviteter. Ved denne teknik ligger patienten på ryggen med benet strakt og foden hængende ud over bænkens kant.

You’re going to position yourself medially to the foot and place the hypothenar of your contralateral hand on the lateral and plantar aspect of the cuboid just proximal to the base of the fifth metatarsal. The hypothenar on the other hand is placed dorsally and medially on the cuboid which is lateral and proximal to the line between the third and the fourth digit.

In this position, the forearms form a straight line and after you fold your hands together ask the patient to make active maximal dorsiflexion which pretensions the cuboid submaximal eversion. Build up compression through your elbows as well as increase the pronation pre-tension direction.

Bed patienten om at slappe af i foden og derefter udføre et pronationssving med begge albuer kombineret med en kompressionsimpuls fra begge hypothenarer.

Som tidligere nævnt er det nødvendigt med en differentialdiagnose, og det første skridt i vurderingen af ankelforstuvninger bør være at udelukke et brud. Så sørg for at læse vores wiki om Ottawas ankelregler som det næste.

21 AF DE MEST NYTTIGE ORTOPÆDISKE TESTS I KLINISK PRAKSIS

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Jennings J, Davies GJ. Behandling af cuboid-syndrom sekundært til lateral ankelforstuvning: en case-serie. Journal of orthopaedic & sports physical therapy. 2005 Jul;35(7):409-15.