Feets Don't Fail Me Now
A concise guide to five runners' foot maladies
Like the tires on your car, your feet are your direct connection to the dirt, rocks and roots ...
Like the tires on your car, your feet are your direct connection to the dirt, rocks and roots—and they take a beating. As a result, foot injuries are common among trail runners. Below is a quick reference guide to five run-stopping injuries, by the Rock `N' Roll Marathon's Medical Director.
Cuboid Syndrome
Cuboid syndrome is a subluxation (partial dislocation) of the cuboid bone in the foot. The cuboid bone essentially moves out of place due to ligaments weakened from repetitive inversion (the foot repeatedly turning inward while running).
The pain is directly under the arch. It mimics plantar fasciitis but does not go away with standard treatments. X-rays and MRIs are usually not helpful because they will appear normal. An examination revealing tenderness on this bone makes the diagnosis. Treatment is conservative, normally involving manipulation and then strapping with tape and/or employing an orthotic with a cuboid pad to hold the bone in place as the ligaments heal. Maximum downtime is six weeks; if a runner is in a hurry, I have seen Platelet-Rich Plasma (PRP) injected into the ligaments to speed healing while the runner wears the strap or orthotic.
In 2009, pro-football quarterback Eli Manning was reported to have a different cuboid condition. News outlets reported that he had a "stress syndrome" of his cuboid bone. Here, the bone becomes stressed from repetitive inversion, and the condition, if not corrected, will lead to a stress fracture. The pain is exactly the same as that of plantar fasciitis, but there is usually less or no pain with palpation of the bone. This is not ligamentous and is easily seen on an MRI. Rest, an orthotic to protect from more inversion and a bone stimulator are useful in healing and preventing a stress fracture. Recovery time varies with the severity, and all bets are off for a quick fix if the syndrome becomes a stress fracture.
Quick Guide: Cuboid Syndrome
- Symptoms: Pain in arch, which mimics plantar fasciitis, but pain not usually seen with first step in the morning.
- How it occurred: Repetitive inversion.
- What the doctor may do: Physical exam. Palpation. Manipulation during physical exam should show relief of pain. Gait analysis.
- Likely treatment: Cuboid pad and no running for six weeks. Repeat manipulation of bone back into place weekly. Orthotic or orthotic adjustment. Platelet-Rich Plasma (PRP) speeds healing of the ligament.
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