From the Guidelines
A cuboid bone stress fracture requires immediate rest, immobilization, and gradual return to activity to prevent further injury and promote healing. The treatment plan should be tailored to the individual's specific needs, but generally, it involves 4-6 weeks of non-weight bearing using crutches or a walking boot, combined with ice application for 15-20 minutes several times daily to reduce inflammation 1. Over-the-counter pain medications like ibuprofen (400-600mg three times daily) or acetaminophen (500-1000mg every 6 hours) can help manage pain.
Key Considerations
- Once pain subsides, physical therapy focusing on foot strengthening exercises and proprioception training should begin, with gradual return to normal activities over 2-3 months.
- Custom orthotics may be recommended to correct biomechanical issues that contributed to the fracture.
- Surgery is rarely needed but may be considered for displaced fractures or those that fail to heal with conservative treatment.
- Cuboid stress fractures occur due to repetitive loading forces, often in athletes or individuals who suddenly increase activity levels, as noted in the context of stress fractures in general 1.
Important Factors
- The cuboid bone is crucial for lateral foot stability and proper weight distribution, making appropriate healing essential to prevent chronic foot problems or recurrent injury.
- Follow-up imaging is typically not needed after a diagnosis of stress fracture is made, but may be necessary if there is an unexpected incomplete response to conservative therapy or if complications such as osteonecrosis are suspected 1.
From the Research
Diagnosis of Cuboid Bone Stress Fracture
- The diagnosis of cuboid bone stress fracture can be challenging due to nonspecific symptoms 2.
- A detailed clinical examination and conventional x-ray picture can provide evidence of a suspected fracture, but further investigation such as bone scintigraphy, CT scan, or magnetic resonance imaging may be necessary to confirm the diagnosis 2, 3.
- Conventional radiographs may not always reveal occult fractures, especially in children, and further investigation may be required 3.
Treatment of Cuboid Bone Stress Fracture
- The treatment of cuboid bone stress fracture depends on the particular fracture characteristics 3.
- Non-displaced isolated fractures of the cuboid bone can be effectively treated conservatively by immobilization and avoiding weight bearing on the injured leg 3.
- Surgical management is mandatory in cases of shortening of the lateral column > 3 mm or articular displacement > 1 mm to avoid negative biomechanical and functional consequences for the foot 3.
- A classification system for fractures of the cuboid has been proposed, and the treatment of these fractures can involve internal fixation, external fixation, or bone grafting 4, 5.
Management of Pain after Treatment
- Acetaminophen can be considered the mainstay for pain relief in patients recovering from extremity fracture surgical procedures, as it has been shown to be noninferior to combination therapy with acetaminophen and tramadol 6.
- The use of acetaminophen can help reduce the risk of side effects and potential habit-forming associated with tramadol 6.