Cuboid fracture or tendon??

[GoldenBC]

I broke the base of my 5th metatarsal in a transverse fracture, 4mm displaced, running close to but not into the space between the 4th and 5th met.  A non-Jones fracture I've been told.  It's now 9 weeks and only minimal healing.  I was pretty much NWB for 4 weeks, then started WB but foot is extremely sore.  Was taken out of a fiberglass cast at 6 weeks, put into an aircast, PWB.  

I still have soreness at the 5th met fracture site, still have bruising all along the outside of my foot, but also extreme soreness and pain behind the 5th met, right where the cuboid bone would be.

Is it possible that after 4 x-rays that I have a cuboid fracture or would that have shown up?  If it's not a fracture, it is possible I've done something to the tendon?  I broke my 5th met in an inversion of the ankle where my ankle bone was actually touching the ground and I couldn't straighten my foot (stepped in a hole).  

My foot and ankle on the lateral side are swollen and stiff still, but the extreme soreness is very localized to just in front of the heel and before the base of the 5th met.

I think I am going to be referred to an ortho surgeon as I've had only "slight" healing according to radiologist reports, plus the soreness, still after 9 weeks.

I am doing ROM exercises with my ankle, and can move it back and forth OK but can't do too many or it hurts.  Can barely move it side to side though and when I do, my outer three toes feel like they've turned to wood and almost feel numb.

[Yena H Do, DPM]

the pain you are describing sounds like the cuboid bone may have been affected.  there is also a peroneal brevis tendon there as well.   it attaches to the base of the 5th met.  if you don't have healing at the fx site by now, you will need to have that surgically fixed.  another option is to continue nonweight bearing and using a bone stimulator.  i recommend getting an MRI to see what is going on.  it will tell you if the cuboid is affected, if the 5th met fx is healing, or if you have tendon involvement.

[anewdeb]

A related discussion, Cuboid Fracture/Fragmented was started.

[GoldenBC]

I've seen the ortho, and while he didn't say this syndrome specifically, it fits with all my symptoms:  Painful OS Peroneum Syndrome.  I know that I do have an OS peroneum as it was noted on the initial x-ray report.

Can you tell me the usual treatment plan for this?  Currently I am on anti-inflammatories, and have been prescribed a special orthotic that will take pressure off that area.  I have been on anti-inflammatories for 3 days with no change yet, so how long until I could expect it to start lessening?

It feels like I have a sharp rock under the cuboid bone, and it's awful to walk on.  I'm in an aircast at the moment to go out anywhere and for some of the time at home as I can't put a shoe on.  If I don't have the aircast at home, I'm on crutches with very little weight on the foot.

The orthopedic surgeon said I didn't have any tendon tears (not sure if I believe that -- I think it may be torn somewhat, though not a big tear).  I have burning along the tendon to just above my ankle, and am swollen just behind the ankle.  Was also very bruised in that area when I did the original injury.

Any additional info you can give would be greatly appreciated.

[GoldenBC]

Forgot to ask:  If there is less soreness, does that mean it's possibly healing (the fracture) or is that just the soft tissue healing?  And if the bone scan shows it's not healed yet, is there a chance it could heal still (after 12 weeks) or is surgery my best bet?  And if some healing has happened, how much would be considered to be good as far as that it will continue?  E.g. if only further slight healing has happened, does that mean it's best to have the surgery as it will take months to be healed properly?  And if it's healing this slowly, will it be quality bone?  I've read that sometimes the bone quality is poor with slow healing, but not sure if that would apply here.

[GoldenBC]

Thanks for your reply.  I am at 12 weeks now, waiting to get into the ortho (Christmas, death in the family, ortho away ...).  I hope to find out my appointment on Monday.  I know from when I saw him for my knee that he often orders a bone scan.  Will a bone scan show if there is cuboid involvement?  My foot isn't as sore now as it was 3 weeks ago, but still gets sore along that side, and I can't tolerate pressure from laying on that side, or heavy blankets, on that side of my foot.  Bruising has finally started to go at the 10 week mark, and is almost gone now, though it's still dark along the lateral side of my foot.