Bruised but not Broken

Well the good news is that the lateral aspect of my right foot is not broken. The attending physician ordered an Xray to determine if I had a stress fracture--I tried to tell him that Xrays don't determine acute stress fractures until the 3rd week after healing has started to occur. MRIs, CT scans, and 3-image bone scans are more successful in identifying early-stage stress fractures. I was not surprised when the radiology report suggested no abnormal findings. The attending physician then sent me on my way without investigating my pain and bruising further; however, he suggested I could attend the sports therapy clinic in the hospital if I wanted to pursue a diagnosis more aggressively. Naturally, I would pursue this avenue--the pain still exists despite a finding of no fracture and I would like to determine the cause so that I may treat it appropriately without risking injuring myself by ignoring it (this is where I get really frustrated with physicians).

After doing my own research into the matter (until I access the sports therapy clinic to get the opinion of an expert) I suspect possible cuboid subluxation. Cuboid syndrome is somewhat obscure and poorly defined in the literature. When conditions are poorly defined in the literature, this usually means that there is a lack of consensus among doctors as to the etiology (reason for the condition) and the treatment. Cuboid syndrome is a common cause of lateral foot pain in the athletic population and is often misdiagnosed or mistreated. Occasionally the symptoms of cuboid syndrome occur without an obvious injury. The symptoms of cuboid syndrome are very similar to the symptoms of a sprain. Pain is significant when weight is first applied to the foot. Pain increases with the toe off phase of gait as the weight of the body and load from the calf muscle are delivered to the lateral (outside) column of the foot. An athlete with a cuboid subluxation will complain of lateral foot pain and weakness in push-off. Rest, ice, and anti-inflammatory medication (I am taking the Indomethacin I use during my arthritis flares) have been helping. I still can't walk flat on my feet, so I bear all my weight on the ball of my right foot. I would use crutches if I had any because hobbling on the ball of my foot puts too much weight on my left leg which is recovering from shin spints.

One of the fun things about running is that it gives one the opportunity to learn, and it seems as if this never stops. No matter how experienced you are there is always something more to learn. This observation is made relevant by several investigations into overuse injuries in runners. These studies show that experienced runners have about the same rate of overuse injuries as beginners. It is not that experienced runners never learn. Certainly some do not and constantly run, and rerun, into the same injury pattern. However, it is likely that a larger percentage cure one injury then develop and improve until they stumble into the next. This is probably because as one area gets stronger the stress load is subsequently re-applied elsewhere. Injuries, thus, tend to march along what is referred to as the “kinetic chain”. Each runner, however, tends to march to the beat of a different drummer. The specific location for an overuse injury is determined by a multitude of factors (e.g., genetics, previous injuries, training factors, etc.). This means that there is not an etched-in-stone-overuse-injury-sequence through which all runners progress (Feet first, then ankles, then shins, then knees, then … ). Thus, it is a good idea for runners to become aware of regions of the body that may become affected and learn a little about the specifics in each region. Knowledge and early warning are a runner’s best friends.

I am thrilled that I don't have a fracture. I am taking the rest of the week off of running so that I may push myself for my next race on Saturday April 7th. Instead, I am attending the gym and adhering to my nutritional plan with planned cheat-days during the week. Fridays are my cheat day. I enjoyed last Friday with friends for a night of drinks, chocolate, Thai food, and Trivial Pursuit. My evenings have been filled with the company of friends--a great distraction during my down-time from training.

References

Stone DA, Kamenski R, Shaw J, Nachazel KMJ, Conti SF, Fu FH. Sports Injuries, Mechanics, Prevention, Treatment-Second Edition. Philadelphia, Lippincott Williams and Wilkin; 2001. pp381-397.2.

Leerar, PJ. Differential Diagnosis of Tarsal Coalition versus Cuboid Syndrome In An Adolescent Athlete. J Orthop Sports Phys Ther 2001; 31(12)3.

Marshall P, Hamilton WG. Cuboid Subluxation In Ballet Dancers. Am J Sport Med 1992; 20(2).4. Mooney M, Maffey-Ward

L. Cuboid Plantar And Dorsal Subluxations: Assesment And Treatment. J Ortho Sports Phys Ther 1994; 20(4).