Foot Orthoses For Chronic Ankle Instability
In light of an increasing body of research on the
Patient
28 year old female, 121 lbs.
Complaint
Lateral forefoot pain, left foot only.
X-Rays
X-rays taken were negative for fractures.
On the lateral view- a narrowing of the dorsal portion of the joint space of the calcaneal cuboid joint.
On the medial oblique view- the base of the fourth metatarsal is 2mm laterally displaced relative to the distal medial point of the cuboid.
Clinical Observations
Palpable pain severe along plantar medial aspect of the cuboid.
Diagnosis
Subluxed cuboid syndrome.
Discussion
This condition is one of the few subluxations of the foot which responds dramatically to digital manipulation. It is an uncommon, but not a rare condition encountered in podiatric practice.
Treatment
Soak the foot in warm water for ten or fifteen minutes to relax and loosen the soft tissues. With the patient in a prone position mobilize the cuneiforms by visualizing the condition as an eversion of the cuboid relative to the calcaneus proximally and the base of the fourth and fifth metatarsals distally. So the motion is to mobilize and invert the cuboid to the proper alignment. Didactic manipulative instruction is needed to master this technique. It’s a good idea to tape the foot to support and assist the soft tissues as they return to their normal length and tension.
Long Term Management
Subluxed cuboids are notorious for their intolerance to orthotics. However, after successful manipulation and healing, foot orthoses are comfortable and certainly indicated for prophylaxis.
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