Join us in an enlightening discussion on peroneal cuboid pain, or cuboid syndrome, an elusive ailment that often appears without any obvious cause. As we navigate this complex issue, we delve into its connection to inversion injuries, its mysterious origin, and the significant role peroneal tendons play in this pain.
We also offer practical advice on how to manage this discomfort, from treating the soft tissue component to the right way to stretch. We touch on the benefits of using heel lifts, firm base footwear, and the useful role of mild supportive orthoses. Looking back on our previous discussions with Sophie Fit on peroneal compartment pain and Mark Blackney's insights on fifth metatarsal fractures provides valuable context. Stay tuned to our podcast, Simply the Best Pediatrics, to unravel more podiatric pain mysteries and acquire practical advice on managing them.
This podcast is recorded and produced on Naarm and Bunurong the traditional lands of the Kulin Nation. We pay our respects to the elders, past present and emerging and the land, seas and skies for which we all live.
Join us in an enlightening discussion on peroneal cuboid pain, or cuboid syndrome, an elusive ailment that often appears without any obvious cause. As we navigate this complex issue, we delve into its connection to inversion injuries, its mysterious origin, and the significant role peroneal tendons play in this pain.
We also offer practical advice on how to manage this discomfort, from treating the soft tissue component to the right way to stretch. We touch on the benefits of using heel lifts, firm base footwear, and the useful role of mild supportive orthoses. Looking back on our previous discussions with Sophie Fit on peroneal compartment pain and Mark Blackney's insights on fifth metatarsal fractures provides valuable context. Stay tuned to our podcast, Simply the Best Pediatrics, to unravel more podiatric pain mysteries and acquire practical advice on managing them.
This podcast is recorded and produced on Naarm and Bunurong the traditional lands of the Kulin Nation. We pay our respects to the elders, past present and emerging and the land, seas and skies for which we all live.
Speaker 1:
Hi there and welcome back to Simply the Best Pediatrics podcast. I'm Jason Agosta and last week we discussed a perineal compartment and tendon pain, and I don't know how we got onto it, but we were talking about the Jordan number 23 episode with Sophie Fit and since then I've thought oh, there was another number 23 and that was Kyra Cooney Cross of the Matildas. But anyway, moving on, we could say that this is the Kobe Bryant episode being number 24. We could keep this going on for week after week, I'm sure. But here is some trivia though Apparently Kobe Bryant changed his number to 24 so he could have a one up on Michael Jordan.
Speaker 1:
I'm not sure how true that is, but so, moving on, today we are going to discuss perineal cuboid pain. This is a very short presentation on perineal cuboid pain, but hopefully we can pass on some quick, easy tips for you. So, moving a little distally from last week's discussion. Commonly known as cuboid syndrome, this is pain sometimes around the lateral maledulus extending down to the fifth metatarsal base, and can also just be around the base of the fifth metatarsal and around the cuboid. Often there is joint pain at the calcaneal cuboid joint and the cuboid metatarsal joints around the outline of the cuboid bone itself. This presents typically as aching and discomfort and a more generalized pain as it involves the perineal tendons and the adjacent joints. The weird thing is that often they come out of nowhere. It can be different to inversion injuries. When we have inversion injuries there may be perineal tendon or joint injury or sometimes the base of the fifth metatarsal injury which we discussed in episode 19 with Mark Blackney. The perineal cuboid pain can be vague and migrating but is usually a definite lateral foot pain that is highlighted sometimes with an inability to fully extend onto the forefoot under full weight bearing in some cases. It's one of those issues that when it comes in, it's like here we go. Sometimes they're a little bit difficult to diagnose and work out what to do due to being at times vague and a little changing. There's no doubt that some inversion injuries can set this off where the perineal tendons rotate the cuboid bone, but often it's a little more of an overuse injury with no significant trauma Palpability.
Speaker 1:
There is pain through the perineal tendons, the calcuboid joint and the metatarsal cuboid joints and the joints between the metatarsals approximately seem to get affected. This is what can contribute to pain extending distally toward the forefoot, not down near the MTPs, but certainly a little more distally. Often there is some perineal compartment tightness or spasm as discussed last week was so fit in Episode 23 which has to be addressed Clinically. This problem can be a little difficult to be specific with as to the region of pain and is one of those issues presenting that is not always easy to fully diagnose. If you're suspicious of anything more than tendon and joint pain, consider your radiology of X-ray and ultrasound and even MRI.
Speaker 1:
Taking your time and palpating is important. Also, mobilizing the cuboid is usually painful. Weight bearing and inverting can stretch the perineals and can be different to the asymptomatic side, and true perineal cuboid pain is usually easy to manage. So that's great news. So what are we going to do from here? Firstly, treating the soft tissue component of the perineal compartments, as so fit discussed, is essential.
Speaker 1:
Gentle stretching the perineals can be helpful but has to be done gently. This is weight bearing and inverting. To accentuate the stretch you need to flex at your knees. So while you're listening to this and if you're standing, invert your foot and flex at both knees, you should feel some perineal tendon stretch. But this has to be gentle. It's important that the stretch is done gently so not to strain anything laterally Into the foot. It is best to get a ball and massage and mobilize while seated through the underside of the foot.
Speaker 1:
Focus has to be on the cuboid region so as to mobilize this lateral part of the foot Gently gently here, though, as it's usually intolerable after 20 or 30 seconds Again, not full force, and just gently, like the stretching With your patient. You can do this by hand and mobilize the cuboid from the plantar aspect of the foot. It's tended to do so and usually doesn't need too much. Mobilizing the cuboid and manipulating can be done with the patient prone. Bring the foot up so the knees flexed and the foot horizontal to the table. Wrap your hands around the mid-tarsal region and the cuboid and plantar flex and distend the foot towards you. This is a little bit difficult to describe on this platform without the visuals, but this can really help mobilize and at times you're going to manipulate the cuboid and there's an audible click into position If there is some subluxation.
Speaker 1:
So easy things to do with lateral foot pain or perineal cuboid pain include taping the mid-tarsal region for support, which usually gives a sense of being more secure. But this is important during weight bearing and if anyone is continuing weight bearing activities, they will need to tape around the mid-tarsal region, as movement and collapse of the mid-tarsal region can be a cause of this pain. There is dysfunction of the lateral column of the foot. Supporting the mid-foot is essential in many cases. Remember that the perineals and the lateral column of the foot are essential for forefoot weight bearing.
Speaker 1:
Using mild support is enough, whether it's with preformed orthoses or other that can be modified easily to achieve good support. It usually doesn't take too much support to assist and, most importantly, you don't want to over correct and support the foot and add to lateral strain or lateral weight bearing. Often the patient can continue with activities, even light activities, and that will be fine. But it may prolong the time that this problem continues on. For Firm base footwear is best in conjunction with mild support and taping. So it's important to have a firm base of shoe to make sure we try and limit any mid-foot extension. So overall this generally can be an easy problem to treat and there are not many cases that linger and persist.
Speaker 1:
Importantly, it seems that pain and disability sometimes outweighs the severity. So we must manage the soft tissue through the perineal compartment, massage and mobilise the plantar aspect of the foot Definitely mobilise the cuboid region. Taping is useful to support the mid-tarsal region. Orthoses of mild support can be useful, as can be firm based footwear. One other thing is using heel lifts. Using heel lifts will limit the extension through the ankle joint and the midfoot and can be a useful modality in conjunction with everything else discussed.
Speaker 1:
Yeah, as I mentioned, if we can maintain some activity, that is good, but this may prolong the time of recovery. It's important to pass that on to the patient though. So this is a brief overview of cuboid pain and follows on from the perineal compartment discussion. I think it's worth going back and listening to episode 19 with Mark Blackney discussing fifth metatarsal fractures, and also last week's episode discussing perineal compartment pain. Hopefully this can assist in providing some advice with some quick little tips. Check the show notes for details and you can follow and support this show through the show notes. There's plenty more in store for you in the coming weeks, including strengthening, and we will begin discussion on orthosis in practice. Stay tuned and thanks for listening to Simply the Best Penitrate, and we'll be with you next week.