: Causes and Management introduction Though rare, an isolated cuboid stress fracture should be considered in a patient presenting with lateral foot pain.
: Causes and Management introduction Though rare, an isolated cuboid stress fracture should be considered in a patient presenting with lateral foot pain. Overuse injuries are a common entity in medical practice. Stress reactions and fractures make up a significant portion of patients in a typical sports medicine clinic.
Due to the repetitive mechanical forces dissipated in the area, the foot is prone to overuse injuries. Isolated stress fractures of the cuboid are rare, with a review of literature showing less than a 1% incidence. This condition should be a consideration in a patient with continual lateral foot or ankle pain, especially if the patient has persistent lateral foot pain, is athletically inclined, and has a history of repetitive use such as running, triathlon, and jumping activities such as ballet.
General risk factors for stress fractures include running, jumping, marching, decreased bone density, female gender, and poor pre-activity conditioning. Furthermore, a specific triad has been associated with the female athlete involving amenorrhea, low bone mineral density, and dietary restraint. This triad has been shown to increase the risk of stress fractures by 30 to 50%.
The initial stage of bone failure is generally called a stress reaction. This diagnosis is made in a symptomatic patient who has a bone scan or MRI evidence of bone periosteal reactive changes without a true fracture line. Many factors influence the risk of stress fractures, these being divided into intrinsic (gender, age, race), extrinsic (training regimen, footwear, surface, sport), biomechanics (bone geometry), hormonal (menses abnormalities, contraception, thyroid) and nutritional (eating disorders).
When found and diagnosed, these isolated cuboid stress fractures are most commonly present in endurance sport athletes (marathon, half-marathon, triathlon), but there are also reports in other sports involving large loading forces on the cuboid, including ballet, gymnastics, basketball, and rugby. In a review of 196 cases of stress fractures (125 fractures in males and 71 in females), the most common site was the tibial shaft (44.4%), followed by the foot (15%), metatarsals (9.7%), and the tarsals (1%). Cuboid stress fractures are less common than fractures in other tarsal bones such as the calcaneus and navicular because the cuboid is not a weight-bearing bone.
If you are experiencing symptoms that may be related to cuboid stress fractures, it is important to see a sports medicine physician. Early evaluation and treatment typically lead to better outcomes. Do not ignore pain or symptoms that are limiting your activity.
*This article is for educational purposes only and does not substitute for professional medical advice. Always consult a qualified healthcare provider.*
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