Tuesday, October 29, 2013

Do You Have Subluxing Cuboid Syndrome? A Pain in the Outside of Your Foot!


Do you have pain and weakness along the outside of your foot? Perhaps you have a history of a traumatic sprain from landing on another person’s foot or falling off a curb. Maybe there is no history of acute trauma but gradual onset of pain over a period of time that doesn’t respond to physical therapy, injections or anti-inflammatories? Sounds like cuboid subluxation syndrome!

What Causes Cuboid Subluxation Syndrome?

Injury to the joints and ligaments around the cuboid bone during an inversion ankle sprain results in cuboid subluxation syndrome. Cuboid syndrome is a common cause of lateral foot pain in the athletic population and is often misdiagnosed or mistreated. It is a minor disruption or subluxation of the structural integrity of the calcaneocuboid portion of the midtarsal joint.

An athlete with a cuboid subluxation will complain of lateral foot pain and weakness in push-off. The pain often radiates to the plantar aspect of the medial foot, the anterior ankle joint or distally along the fourth ray. It is common in ballet dancers and runners.

During a physical exam, there is pain upon palpation on the plantar surface of the cuboid. Sometimes the subluxation can be reproduced, but not often since it is usually subtle. It is important to be aware that diagnosing cuboid syndrome via radiographs, computerized axial tomography (CT) scans or magnetic resonance imaging (MRI) is difficult because of the normal variations that exist between the cuboid and its surrounding structures, and the minimal amount of subluxation that is usually present.
What else could it be? 

  • ·      Sinus tarsi syndrome

  • ·      Lateral process fracture of the talus

  • ·      Acute tendinitis of the peroneus longus tendon

  • ·      Fracture of the anterior process of the calcaneus
  • ·      Malalignment of the lateral ankle and subtalar joints

  • ·      Fractures (including stress fractures)

  • ·      Gout
Inflammatory and noninflammatory arthritis

  • ·      Tarsal coalitions (in adolescents)

Once one has diagnosed cuboid syndrome, reducing the subluxed cuboid is the first step in the treatment process. Clinicians may employ a manipulative technique, which is often defined as a low-amplitude, high-velocity mobilization at the end of joint range, to restore proper joint congruency.
Afterward, patients should use a cuboid pad in conjunction with a taping technique to maintain the cuboid reduction and give the arch added support.
 Keep in mind that the cuboid pad may at times spontaneously adjust a mildly subluxed cuboid by its upward thrust.
Long-term treatment is a semirigid orthotic with a cuboid pad placed on the device. Physical therapy techniques are often used to return normal foot function. Patients may gradually return to sports activity when the pain subsides.
Keep in mind that cuboid subluxation following a second-degree or third-degree lateral foot sprain requires special care in order to prevent the development of a chronic condition. If one suspects a cuboid subluxation after a lateral foot sprain, reduction is not attempted until the swelling and bruising have significantly diminished and the possibility of a fracture has been ruled out.
Bottom line: after an inversion sprain, if you still have lateral foot pain once the swelling has gone down, you may have subluxing cuboid syndrome. An evaluation and treatment of a subluxed cuboid is essential in order to restore normal joint range of motion, alleviate pain and improve foot function.

Tuesday, October 22, 2013

It's Time For Dallas Athletes Monster Triathlons 2013


Halloween season means it’s time for the Dallas Athletes Monster Triathlon series. Unfortunately it’s also very cold outside in the wee hours of the morning! The start of the Denton version of the sprint series was very chilly, but a fun time was had by all! Lots of great costumes and Halloween cheer!

This weekend is the kid’s triathlon on Saturday and the Keller sprint on Sunday! The kid’s tri is always a blast! I love to see parents contaminating their children in a good way! The kids are of all ages and there is always a few tots on tricycles to warm all of our hearts.

I’m looking forward to more good costumes and pancakes on Sunday morning! There are lots of first timers signed up so don’t be scared! You too can try a tri!



Happy end of the season for most triathletes! Join us at Monster this weekend for a monster mash!!!

On to marathon season…….

Tuesday, October 8, 2013

Why Do My Shins Hurt After I Run?


I ran the Lake Grapevine Runners and Walkers Double Trouble 5K/10K duo this weekend. Fun! Crazy weather! It started out at 78 degrees and was down to 52 when we finished the 10K portion.  Got to love a good cold front! A good time was had by all, and it’s great to see everyone out at the lake.

My funny story for the day was that one of the runners sidled up next to me and asked, “Why do you think my shins hurt after I run?” and “How come they don’t hurt when I’m running?” Of course, my first reaction was “It depends….”, and “Good question. Let me catch my breath and I might have an intelligent answer for you.”

Here was my answer:

Your shins can hurt after running for a variety of reasons. The most common is a shin splint. This is actually a term commonly used to describe medial tibial stress syndrome.  What? Yes, stress causes pain along your shin bone and can even cause a stress fracture. In the early stages the painis actually myositis (irriation of the muscle that runs along the shin bone) and this will “warm up” when you run. Stress fractures don’t “warm up.”

Why does this happen? Most common reason is either worn out running shoes or inappropriate shoes to start with. If you have a very high arch, you need a more cushioned shoe. If you have a flat or low arched foot, you need a more stable shoe. Lots of times you just need to part with your old beloved super worn-out running shoes.

Other reasons can be a change in surface like going from the treadmill to concrete. Or a rapid increase in training mileage or increased speed.

When is it time to stop the home remedies and go to the doctor?
Pain 5-7/10 or in a pinpoint spot can indicated a stress fracture!
Pain that has lasted more than a few weeks with rest, ice and over-the-counter anti-inflammatories.
Lastly, if you have changed shoes, tried stretching and icing and still have pain daily….time to come in for a visit.

Some people need help buying shoes, some people need functional foot orthotics to re-align their gait and some people need to rehab their injury with physical therapy.

So the take home point is that your shins shouldn’t hurt after you run!! If they do, you should take a look at you shoes and training patterns! When in doubt, give us a call so we can take a look and make your shin pain go away!

FAANT gave away cute little Body Glide buddies for your gym bag at the race! Adorable!