What is the treatment for a fractured cuboid bone of the foot?

Treatment for Fractured Cuboid Bone of the Foot

For cuboid fractures, treatment should be based on the degree of displacement, with non-displaced fractures managed conservatively through immobilization, while displaced fractures require surgical intervention to restore lateral column length and articular congruity.

Diagnostic Evaluation

• Initial assessment with weight-bearing plain radiographs to evaluate fracture pattern and displacement 1
• MRI is recommended for radiographically occult fractures, as it allows visualization of bone marrow edema patterns 1
• CT scan is useful for detailed fracture characterization, especially for surgical planning 1

Treatment Algorithm

Non-Displaced Fractures

• Conservative management:
  • Immobilization with cast or removable walker boot for 4-6 weeks 1, 2
  • Non-weight bearing or protected weight bearing during initial healing phase
  • Progressive weight bearing after initial immobilization period
  • Appropriate footwear and arch supports may be necessary after immobilization 2

Displaced Fractures

• Surgical intervention is indicated when:

  • Articular displacement >1mm 3
  • Shortening of the lateral column of the foot 3
  • Significant disruption of midfoot stability 4

• Surgical options:

  • Open reduction and internal fixation (ORIF) 5, 3
  • Bone grafting to restore lateral column length when necessary 5, 3
  • External fixation in cases with significant soft tissue compromise 4

Post-Treatment Management

• For conservative treatment:

  • Protected weight bearing for 6-8 weeks
  • Progressive return to activities after radiographic evidence of healing

• For surgical treatment:

  • Non-weight bearing for 6-8 weeks
  • Prolonged immobilization followed by 3 months of progressive weight bearing 4
  • Regular follow-up with radiographs to assess healing

Special Considerations

• Stress fractures of the cuboid:

  • Commonly seen in athletes 2
  • Treatment primarily consists of immobilization and activity modification 2
  • May require foot orthotic devices and appropriate footwear adjustments 2

• Diabetic patients with cuboid fractures:

  • Higher risk of complications including delayed healing and infection
  • May require more aggressive offloading with specialized devices like total contact casts 1
  • Careful monitoring for signs of infection is essential 1

Potential Complications

• Long-term foot pain if not properly managed 3
• Lateral column shortening leading to foot deformity 3
• Post-traumatic arthritis in adjacent joints 4
• Midfoot instability 4

The evidence for cuboid fracture management is limited due to the rarity of these injuries 6, but the consensus supports that restoration of lateral column length and articular congruity are critical factors in determining treatment approach and outcomes 6, 3.