How I managed the cuboid subluxation.

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Case introduction :

• ?A young guy aged 19 came to the clinic on Saturday with complaints of heavy pain, foot range of motion complaints and feeling like locking of the foot while walking with massive pain Foot pain on the outside, especially when pushed on the ground.
• Mechanism of injury explained inversion of the ankle during the high jump to land since the pain followed by.

Assessment:

• I? took the mechanism of injury into the assessment followed by diagnosis using palpation, range of motion assessment, and specific tests the midtarsal adduction test. Palpation detects tender points, range of motion assesses foot and ankle mobility, and the midtarsal adduction test checks for pain and instability. The tests for midtarsal adduction and supination involve stabilising the calcaneus while passively moving the midtarsal joint in the transverse plane. The supination test includes inversion and plantar flexion. Passive translation of the cuboid can cause pain. before I proceeded with the physical examination I made sure there were no red flags the patient didn’t have any signs of fracture apart from a little bit of swelling which also had calcaneocuboid joint tenderness, which is common in part of the Injury. In the subjective assessment, the patient explained he had a history of subluxation. For an extensive understanding of the current condition assess the peroneus longus tendon tenderness. The previous injuries were left untreated especially since there was no long-term rehabilitation patient must have weakness and poor lateral ankle stability complaints.
• **** While doing the examinations exclude the possible differential diagnosis using pattern recognition, location of the pain and neurovascular examinations.
• ?A few intriguing observations made during the examination included the fact that the primary function of the Flexor Hallucis longus muscle, which has an indirect relationship to the injury, is the Flexion of the great toe. further maintains the distal pad of the great toe in touch with the ground during toe-off and tip-toeing and stabilises the first metatarsal head. The muscle helps to keep the medial longitudinal arch in place. The foot pronates when the muscle is unable to maintain the arch, applying extra strain on it, which leads to medial and posterior-lateral foot instability issues due to overusing.
• Management:

Manipulations:

Cuboid manipulation is frequently advised as the first treatment for cuboid syndrome?unless it is contraindicated by conditions such as bone disease, inflammatory arthritis, gout, neurological or vascular damage, or fracture.? For manipulation, rely on two techniques cuboid whip and cuboid squeeze. The cuboid whip was chosen over the cuboid squeeze because the patient has a history of lateral ankle instability, which might lead to consequences such as instability or sprain.

?Kinesio Taping:

Following the manipulations, it is time to stabilise the joint with tape. I taped in such a way that I maintained strong arch support while also receiving aid for lateral medial joint instability from anchoring to the anterior leg.?Additionally, it promotes the range of motion in the ankle and foot.

Exercises:

In addressing a clinical history of lateral instability, I have introduced a comprehensive exercise regimen to enhance foot stability. Focusing on the tibialis posterior and intrinsic foot muscles aids in fortifying the medial arch, which is crucial for lateral stability. Additionally, peroneal longus muscle strengthening exercises target lateral support. Incorporating flexor hallucis longus exercises maintains arch integrity, while tibial anterior and calf stretching alleviates tension in the posterior arch. By imparting these exercises to the patient, a holistic approach is taken to promote foot strength, balance, and flexibility, ultimately mitigating the risk of lateral instability and fostering overall foot health.

Ambulant Physiotherapy Ltd ?

****For extensive reading about cuboid subluxation please read the following.

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Angoules, A. G., Angoules, N. A., Georgoudis, M., & Kapetanakis, S. (2019). Update on diagnosis and management of cuboid fractures.?World journal of orthopedics,?10(2), 71–80. https://doi.org/10.5312/wjo.v10.i2.71