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Cuboid Syndrome as Complication from Open Fasciotomy

Posted by judyml on 9/26/01 at 21:38 (061684)

I would like to know from either the docs or others posting to this board if anyone has developed a cuboid syndrome after open fasciotomy. I am now 2 months post op and i do have numb areas in the bottom of my foot. My doctor is treating me with ultrasound therapy, prednisone and i am now using a cam boot. The other day he fitted me for orthotics which I should have in about 1 month. He also gave me a 'trigger point' injection in my calf the other day. He has manipulated the cuboid bone back into place on two occasions. I can actually feel the bone on the bottom of my foot due to the swelling.
I am just so depressed with this new diagnosis. My doctor tells me it is unfortunately, a complication of open fasciotomy that some people get...well my luck, I got it.
He assures me it will all get better. I am also concerned about the numbness that I still have.
I hope to hear from someone soon.
Thanks

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/26/01 at 23:02 (061703)

Judyml:

Cuboid syndrome is a potential complication of plantar fascial release- open, EPF or minimal incision. Some feel that the issue is not the technique but whether the entire fascia is cut or the lateral portion left intact. Usually, cuboid syndrome does not last very long though with treatment.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/27/01 at 09:03 (061718)

Dr Ed...
Can the cuboid syndrome be causing the numbness I feel in my little toe and on the lateral portion of the bottom of my foot? What treatment do you prescribe for cuboid syndrome?
Thank you for your reply.
Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/27/01 at 20:41 (061759)

Judyml:

The treatment for cuboid syndrome includes manipulation of the cuboid, possible injection of the calcaneocuboid joint, but, most importantly in my mind adjusting the orthotic to better support the lateral column.

Is the numbness intermittent or constant?
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/27/01 at 21:34 (061766)

Hi Dr. Ed,
The numbness is constant. The doctor had manipulated the cuboid and he said he felt it click in; i still have alot of tenderness on the bottom of my foot where the cuboid is. I am now wearing the cam boot in the hopes that I will take enough pressure off the bottom of my foot to hopefully allow the numbness to go away and the cuboid bone to heal and I am also taking the prednisone which I hope will clear up any inflammation. Only the other day did my doctor take the mold of my feet to make me a set of orthotics.
Do you feel there is a possibility that the reason I have so much numbness on the lateral part of my foot is that when I walk I am walking with my weight distributed more on that part of my foot causing the numbness in my little toe and lateral part of my foot?
You mentioned injection of the calcaneocuboid joint. Would that be done with cortisone? The cortisone I received pre-op never eased the pain for me at that time so I might be just a bit hesitant now.
I am hoping there is no permanent nerve damage which is causing the numbness and my doctor assured me that he did not cut into any major nerves. He told me though I would need to wait about 6 months before I could undergo any tests to see whether I have permanent nerve damage.
Thanks
Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/28/01 at 18:39 (061822)

judymyl:

Your assessment sounds reasonable. I would hope that the numbness and pain is due to weight transferance to the outside of the foot as opposed to a damaged nerve.

The injection would not be to the plantar fascia as was done pre-operatively but to the calcaneocuboid joint instead--using a small amount of a local anesthetic and 'cortisone.'
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Dr. Zuckerman on 9/28/01 at 20:49 (061835)

Hi,

I like good old fashion low dye taping after the foot manipulation and or the local steriod injection. The key is to jump on this quickly and not
hope it will get better on its own.

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/29/01 at 08:38 (061848)

Dr. Zuckerman:

What exactly is low dye taping?

Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/29/01 at 09:56 (061856)

I agree---it really helps to treat this quickly, not giving it a chance to progess. I tend to follow plantar fascial release patients fairly carefully to keep an eye out for this.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/29/01 at 09:57 (061857)

The low dye taping is one of the more frequently used tapings for plantar fasciitis. It can be used post-operatively too in order to support the structures of the arch.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Dr. Zuckerman on 9/29/01 at 13:31 (061863)

It is a taping method which placed the foot in a neutral position and reduces stress on the plantar fascia. Very effective taping . Was developed by a Dr. Ralph Dye over fifty years ago and still used today by
many podiatrists.

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/29/01 at 14:38 (061874)

Dr. Ed
Would the low dye taping help to ease the Cuboid syndrome and possibly then alleviate the numbness I have? What about the Cam boot? Are you a believer in that? I feel great when I walk in it and I even manage to drive my car while wearing it, however, I would like to hope that in the near future, my foot will be back to what it used to be. I feel the open fasciotomy helped the original problem but now I am left with other problems, namely the cuboid syndrome and numbness. My doctor has assured me that he did not cut any 'major' nerve, however, he told me that in the process much smaller nerves are cut but he does not feel that this should cause the numbness that I have.
I did not put on the cam boot today and I noticed that I am feeling some weakness in the lateral ankle of my right foot. Is this a side effect of wearing the cam boot?
Thank you so much for your responses, Dr. Ed and Dr. Zuckerman

Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/26/01 at 23:02 (061703)

Judyml:

Cuboid syndrome is a potential complication of plantar fascial release- open, EPF or minimal incision. Some feel that the issue is not the technique but whether the entire fascia is cut or the lateral portion left intact. Usually, cuboid syndrome does not last very long though with treatment.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/27/01 at 09:03 (061718)

Dr Ed...
Can the cuboid syndrome be causing the numbness I feel in my little toe and on the lateral portion of the bottom of my foot? What treatment do you prescribe for cuboid syndrome?
Thank you for your reply.
Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/27/01 at 20:41 (061759)

Judyml:

The treatment for cuboid syndrome includes manipulation of the cuboid, possible injection of the calcaneocuboid joint, but, most importantly in my mind adjusting the orthotic to better support the lateral column.

Is the numbness intermittent or constant?
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/27/01 at 21:34 (061766)

Hi Dr. Ed,
The numbness is constant. The doctor had manipulated the cuboid and he said he felt it click in; i still have alot of tenderness on the bottom of my foot where the cuboid is. I am now wearing the cam boot in the hopes that I will take enough pressure off the bottom of my foot to hopefully allow the numbness to go away and the cuboid bone to heal and I am also taking the prednisone which I hope will clear up any inflammation. Only the other day did my doctor take the mold of my feet to make me a set of orthotics.
Do you feel there is a possibility that the reason I have so much numbness on the lateral part of my foot is that when I walk I am walking with my weight distributed more on that part of my foot causing the numbness in my little toe and lateral part of my foot?
You mentioned injection of the calcaneocuboid joint. Would that be done with cortisone? The cortisone I received pre-op never eased the pain for me at that time so I might be just a bit hesitant now.
I am hoping there is no permanent nerve damage which is causing the numbness and my doctor assured me that he did not cut into any major nerves. He told me though I would need to wait about 6 months before I could undergo any tests to see whether I have permanent nerve damage.
Thanks
Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/28/01 at 18:39 (061822)

judymyl:

Your assessment sounds reasonable. I would hope that the numbness and pain is due to weight transferance to the outside of the foot as opposed to a damaged nerve.

The injection would not be to the plantar fascia as was done pre-operatively but to the calcaneocuboid joint instead--using a small amount of a local anesthetic and 'cortisone.'
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Dr. Zuckerman on 9/28/01 at 20:49 (061835)

Hi,

I like good old fashion low dye taping after the foot manipulation and or the local steriod injection. The key is to jump on this quickly and not
hope it will get better on its own.

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/29/01 at 08:38 (061848)

Dr. Zuckerman:

What exactly is low dye taping?

Judy

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/29/01 at 09:56 (061856)

I agree---it really helps to treat this quickly, not giving it a chance to progess. I tend to follow plantar fascial release patients fairly carefully to keep an eye out for this.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Ed Davis, DPM on 9/29/01 at 09:57 (061857)

The low dye taping is one of the more frequently used tapings for plantar fasciitis. It can be used post-operatively too in order to support the structures of the arch.
Ed

Re: Cuboid Syndrome as Complication from Open Fasciotomy

Dr. Zuckerman on 9/29/01 at 13:31 (061863)

It is a taping method which placed the foot in a neutral position and reduces stress on the plantar fascia. Very effective taping . Was developed by a Dr. Ralph Dye over fifty years ago and still used today by
many podiatrists.

Re: Cuboid Syndrome as Complication from Open Fasciotomy

judyml on 9/29/01 at 14:38 (061874)

Dr. Ed
Would the low dye taping help to ease the Cuboid syndrome and possibly then alleviate the numbness I have? What about the Cam boot? Are you a believer in that? I feel great when I walk in it and I even manage to drive my car while wearing it, however, I would like to hope that in the near future, my foot will be back to what it used to be. I feel the open fasciotomy helped the original problem but now I am left with other problems, namely the cuboid syndrome and numbness. My doctor has assured me that he did not cut any 'major' nerve, however, he told me that in the process much smaller nerves are cut but he does not feel that this should cause the numbness that I have.
I did not put on the cam boot today and I noticed that I am feeling some weakness in the lateral ankle of my right foot. Is this a side effect of wearing the cam boot?
Thank you so much for your responses, Dr. Ed and Dr. Zuckerman

Judy