Lateral Foot Pain - Cuboid Syndrome – Part Two

Symptoms

Patients who have cuboid syndrome often complain of lateral foot pain, or weakness in their feet. Pain from cuboid syndrome can also radiate to the front of the ankle. This pain is often more noticeable during time of exertion (toe-off portion of the gait cycle), or on impact.

The type of pain found in cuboid syndrome may not be a very good indication of this condition.Pain can be intermittent, or persistent, it can also develop suddenly or slowly over a period of time.

Diagnosis and Imaging

Upon physical examination, the patient may have pain directly over the cuboid bone (especially when pressure is applied dorsally on the plantar surface). In some cases there may be bruising, redness and swelling. Range of motion in the ankle is often limited in cuboid syndrome (dorsi and plantar flexion).

X-rays, CT scans or MRIs are of little value in the diagnosis of cuboid syndrome. The only reason an X-ray is of value in the diagnosis of this syndrome is to rule out fractures or some type of pathological condition.

Treatment

Several forms of manual therapy can be used in treating this condition. The sooner that treatment is implemented the faster the results will be.

• Manipulation: One of the most successful treatments we have found is manual manipulation. A therapist training in extremity manipulation (chiropractor, physiotherapist, podiatrist) can often reduce the pain of cuboid syndrome in a short period of time.

• Soft tissue techniques: Techniques such as Active Release, Graston, Massage Therapy, and Fascial Manipulation can also be of great help. The key is to work with all of the structures involved in the kinetic chain, not only at the site of pain.
• For example we know that the peroneus longus muscle is involved in plantar flexion of ankle, and that this greatly affects cuboid stability. A problem with the peroneus longus could create an alteration in the normal plantar flexion movement. Even though the peroneus longus is most likely involved in this injury, we cannot take it for granted that this is the only plantar flexor affected. Treatment of all plantar flexors and their antagonist muscles, the dorsi flexors, is often needed for a full resolution.
• Plantar flexors: Calf muscles (Gastrocnemius & Soleus), Tibialis Posterior, Flexor Digitorum Longus, Flexor Hallucis Longus, Peroneus Longus, Peroneus Brevis, and Plantaris.
• Dorsi flexors: Tibialis Anterior, Extensor Digitorum Longus, Extensor Hallucis Longus.
• Exercise: Exercises should focus on stretching the peroneus longus and the calf muscles.These stretches are combined with strengthening the extrinsic muscles of the foot. In addition, it is essential to perform balance exercises so that the injury does not reoccur.Please go to www.releaseyourbody.com for a specific exercise needed to rehabilitate this injury.
• Orthotics: Custom fit orthotics will help to correct abnormal pronation and supination that may be leading to cuboid syndrome.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Blakeslee TJ, Morris JL. Cuboid syndrome and the significance of midtarsal joint stability. J Am Podiatr Med Assoc. 1987;77:638-642.

Marshall P, Hamilton WG. Cuboid subluxation in ballet dancers. Am J Sports Med.1992;20:169-175.

Mooney M, Maffey-Ward L. Cuboid plantar and dorsal subluxations: assessment and treatment. J Orthop Sports Phys Ther. 1994;20:220-226.

Newell SG, Woodle A. Cuboid syndrome. Phys Sports Med. 1981;9:71-76.

Lateral Foot Pain - Cuboid Syndrome - Part 1

Lateral Foot Pain - Cuboid Syndrome – Part One

Cuboid syndrome is a condition that causes lateral foot pain. In forty percent of cases Cuboid syndrome is associated with lateral ankle sprains (inversion sprain). This syndrome affects the joint (capsule), ligaments, and tendons (peroneus longus tendon).

This syndrome is defined as a “minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint”. In laymen’s terms, the cuboid bone has moved from its normal position in the joint.

It is a common syndrome, but not well-recognized by practitioners. Cuboid syndrome also goes by several other names: subluxated cuboid, dropped cuboid, cuboid fault syndrome, and lateral plantar neuritis.

Anatomy/Biomechanics

The calcaneocuboid joint is a vital link in lateral foot stability. This joint is susceptible to sudden injury or chronic strain, which can cause this joint to partially dislocate or subluxate.

The cuboid bone is one of the seven tarsal bones of the foot.

• Joint Anatomy: The cuboid articulates with the fourth and fifth metatarsals forming a joint (tarsometatarsal joint). It also articulates with the heel bone (calcaneus), forming a joint (calcaneocuboid joint). On the inside (medially) the cuboid articulates with two bones (lateral cuneiform and the navicular). An alteration of the cuboid can have a considerable effect on the joint biomechanics of the foot.

If we were to view the bottom of the cuboid bone we would see a groove where the tendon of the peroneus longus muscle runs along it.

• Peroneus Anatomy: The peroneus longus muscle originates on the lateral lower leg (upper one-third of the fibula). It then runs down around the outside of the ankle (lateral malleolus) then through the grove on the bottom of the cuboid. It then inserts into the base of the first metatarsal (and cuneiform).

The peroneus longus acts as a stabilizer of the forefoot. The cuboid bone acts as a pulley which increases mechanical advantage for the peroneus longus muscle.

Causes

A single impact injury or repetitive motion can cause this syndrome to occur. Runners and dancers (especially ballet dancers) are susceptible to this injury because of the high levels of repetitive impact. In addition basketball players or racquet sport players also are susceptible due to the lateral motions required to play these sports.

If a person abnormally pronates their foot during the push off phase of gait, they will be more susceptible to a cuboid injury. Excessive pronation causes an increase in force transferred to the cuboid bone which causes instability and a resultant injury.

In part two of Cuboid Syndrome we will cover, symptoms, examination, diagnosis, and treatment.

Lateral foot pain part two...

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Shoulder–to–Arm Kinetic Chain - Forward Posture

It is very easy for you to learn how to become aware of your shoulder–to–arm kinetic chain and how this kinetic chain affects your ability to perform tasks! Lets take a look at a common upper extremity syndrome known as Forward Shoulder Posture (FSP). FSP is common among office workers, students, and probably over half of the patients who walk through my front office doors.

Anatomically Neutral Position

People with FSP exhibit rolled-forward shoulders, with a forward-tilted head, and raised shoulder blades. The onset of these postural changes is so slow and gradual that the majority of people don’t even realize that they are exhibiting these postures when they sit or stand. In addition to these obvious postural changes, numerous mechanical changes also take place within their musculoskeletal and nervous systems.

Try the following test to experience just what happens to your wrist, elbow, hands, and neck with FSP!

1. Starting Position: Stand up with your shoulders back, arms by your side, and your palms facing forward. Click on image for a large photo.
This is known as an Anatomically Neutral Position. In this position your thumbs will naturally point out to the side (externally rotated).

2. FSP Posture: Now relax your arms and roll your shoulders as far forward as you can. This position causes your elbows and wrist to rotate inward (internally rotated), and your thumbs now point towards your body.

3. Test Your Kinetic Chain: Keeping your shoulders rotated forward, pre- tend that you are holding a pen and writing on an imaginary piece of paper. The first thing you will feel is the increased tension in your elbows, wrists, hands, and neck.

4. Now try performing some of your daily living tasks in this position

Can you feel all the tension that would develop in all these areas? And can you see how much energy you waste by maintaining this energy– inefficient posture. Most people don’t realize that poor posture not only causes injuries, but also saps your energy!

What you just experienced are some of the more obvious stresses placed on your kinetic chain by Forward Shoulder Posture. Unfortunately, most of the other changes that take place are not so obvious! The tension from FSP creates friction that results in micro- tears and adhesion formation in your muscles, ligaments, and tendons. These changes cause inflammation and the formation of scar tissue.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Aerobic/Anaerobic Exercise is Essential

Aerobic or cardiovascular exercise is all about increasing your aerobic capacity, improving circulatory function, and increasing energy production. Aerobic exercise does this by increasing the density of capillaries in your muscles and by increasing the level of mitochondrial function in your cells. When you have more capillaries, your cells are able to obtain more nutrients for repair and work, and are able to get rid of waste by-products much more rapidly.

Your mitochondria are the principal energy producers in your cells. Mitochondria convert nutrients into ATP (adenosine triphosphate), a readily–metabolized form of energy used by all living cells. The more energy you have, the easier it is for your body to heal itself and power all the tasks you must perform each day.

Aerobic exercises also promote the loss of excess fat and increases your metabolic rate. In addition, aerobic exercises increase the sensitivity of your cells to insulin, and help your body to better regulate its sugar levels. This is very important for all of us to keep in mind since over 7% of our population now suffers from diabetes; and with increasing rates of obesity, more people are at risk than ever before.

Anaerobic exercise (exercising with reduced blood oxygen levels) is also very important for performance or athletic training. Just like weight training, anaerobic training also promotes the production of Human Growth Hormone (HGH). Research has shown that short intense bursts of anaerobic activity produces high levels of lactic acid. In a high–lactic acid environment, your body increases production of HGH. This means that when we combine anaerobic activity with weight training, we can substantially increase our HGH levels. Bottom line: we will be stronger, leaner, fitter, and healthier.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)

Rehab Principle #1: No Pain ... All Gain!

Rehabilitation (unlike athletic training) requires that you perform your exercises within a completely pain-free zone; essentially a zone of safety.

Exercising in a manner that causes pain develops abnormal neuromuscular patterns that may lead to further injury. Conventional rehabilitation strategies commonly do not succeed because they do not address the underlying neuromuscular problems. They are often designed to make you work through your pain (as in work- hardening programs). This only causes you to create or reinforce the abnormal motor responses which in turn continues to keep you in pain.

In addition, if you work through pain caused by tissue damage you run the risk of central sensitization. This is a nervous system process which causes you to become more sensitive to pain. The only way to break this pattern is to perform your exercises in a pain-free zone.

We commonly have patients come to our clinic who have exercised through their pain for years! They are always amazed at how, by exercising within a pain-free zone, we were able to help them break their pain- cycle in just a few short weeks.

What works will vary from person to person so listen to your body and adjust the routines accordingly.

Bottom line:

Never work through injury pain. If you have an injury, and the exercise hurts during certain motions, or if you feel pain when resting, then restrict the range of motion of the exercise to lie within your pain-free range.

In addition, avoid the exercises that currently cause you pain, until your body is ready for them. To truly rehabilitate your injuries, you must work within a pain-free zone.

This is quite different from training to improve your performance where you may have to endure some degree of muscle pain (not injury pain) to improve strength and endurance.

If you would like more information or to purchase our books please go to www.releaseyourbody.com . 

If you would like information about our clinic in Calgary Alberta please go to www.kinetichealth.ca.

(COPYRIGHT KINETIC HEALTH 2012 – ALL RIGHTS RESERVED)