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Fallen, MRI showed bruises on cupid bone. Pain aggravates by walking. Relief with air cast boot. Treatment?

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Orthopaedic Surgeon
Practicing since : 1995
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I fell about three to three and a half meters on to my left foot. Mri scans showed some bruising to the cuboid bone some four months after the accident. Their was also some evidence of fluid around the third toe... Apart from this the X-rays, MRIs were described as unremarkable. An orthopaedic specilist provided by insurance recommended podietrist treatment and suggested orthotic insoles.

It would seem the first orthotic insoles provided were incorrectly made. They initially cause severe pain to walk in. But after the Podiatrist insisted I continue trying to walk through the pain I was experiencing in them I eventually was told to discard them when my foot began swelling (not gout) and I experienced excruciating pain on the top of my foot. Apparently an overcorrection of my foots gait caused nerve compression etc.. A new Podiatrist was provided and new orthotic insoles prescribed.

Podietrist diagnoses to date are capsulitis third toe and cuboid syndrome. By none weight bearing and wearing a air cast boot (moonboot) the symptoms of pain on my left foot... Reduces to a mild 1-2out of 10 but while I have normal range of motion when resuming normal weight bearing ie walking 1 mile the pain in my foot returns to the point it becomes quite uncomfortable continuing walking 5 out of 10.
The pain lasts and hours later normally at night a throbing feeling but some times a very sharp shock shooting pain at the cuboid can still be felt. Continued activity makes the problem worse so I rest my foot and recover. This is after 8 months from the date of injury. I was examined by an insuance provided orthopedic surgeon who examined my foot after days of rest and instructed me to only discuss the pain I was experiencing at the time of the appointment. Thus excluding most of the problems I experience during prolonged weight bearing activities. He advised the insurance I should be fit to return to work. I feel this opinion by limiting the information I could supply and not inquiring into the difficulties I still experienced was biased and there to serve the insurance companies interest.

So my question. I have a choice to make. 1 is return to my pre-injury employment occupation which involves climbing ladders carrying about 18kgs weight (design of the ladder means placing most of my weight on the forefoot). Operating elevated platforms again heavy use of feet required with the control peddles placing most weight on my left foot in particular my left forefoot and ankle due to the sloping ground the platforms (cherry pickers) operate on. The rest of my work duties also are quite hard on the feet being an outdoor rough ground labouring environment.

Or 2 seeking new employment in an environment eg retail sales in a carpeted environment or perhaps operating a vehicle small truck or forklift where only light to normal weight bearing activies are required.

The insurance won't pay for more treatment. My claim is at an end. I have been provided with a new set of orthotics. That's it as far as they're concerned.

Based on the information provided and the discription of ongoing pain I suffer. Could a return to my prior employment activities resonably cause any further aggravation of problems or even the possibility of arthritis in the joints abutting the cuboid in latter life or any other foreseeable problems if I just 'suck it up and try and put up with the pain'? I am terribly worried about being left with an even worse permanent ongoing injury. Is it a case of put up with the pain and shut up. Or don't risk aggravating things and find a lighter type job to do? I have no resorces to fund any new further investigation or treatments at the present time and must make a choice about my employment future with my insurance cover ending. With the problem persisting so long after the injury and the worry of making my situation worse than now what would you suggest.

Thank you
Age: 40 years male
Posted Thu, 4 Jul 2013 in Bones, Muscles and Joints
Answered by Dr. Mukesh Tiwari 1 hour later
I have read your query.

It looks from your details that you had injury to your foot about 8 months age. You are continuously under treatment from your podiatrist provided from your insurance company. Your pain is aggravated by walking & putting weight on your foot. You are only having relief with air cast boot.

Looking at all these details i am of opinion that you are having problem with cuboid bone.Your previous MRI had also shown edema on cuboid. The edema in cuboid is a clear indication of injury to cuboid after trauma. At present you should do following to have relief in this-

-After the 8 month of injury.It is right to consult to an experienced podiatrist who may do a manipulation therapy to your cuboid. This is the right method of treatment with person who do have cuboid syndrome.

-You should continue to use special TAPES which are applied & known as TAPPING TECHNIQUE.This will help to heal your tissues.

-Take help of a good physiotherapist .You do need non thermal ultrasound therapy ,wax bath therapy for relief.

-There are some preparation available in market.I used to give preparation which have collagen ,glucosamine preparations for such patients.

-If you can have access to a trained massage therapist then it will also help you to get relief from this.

-I will not allow you to go for strenuous work at this stage.I shall advice you to wait for 2-3 months more after having above therapies.You may have a good analgesic.I used to prescribe aceclofenac in such conditions.

Hope this all will help you.

With best wishes.
Above answer was peer-reviewed by
Follow-up: Fallen, MRI showed bruises on cupid bone. Pain aggravates by walking. Relief with air cast boot. Treatment? 11 hours later

I would like to clarify my insurance is NOT providing continuing treatment. I need to return to work and can’t afford continuing treatment. So until I can and while I’m still experiencing pain, I am asking this question to see what type of work I can do without causing further problems to my foot.

You advised me not to do strenuous work at this stage. My regular medical doctor agrees with you. He has told me I run a high risk of causing further injury if I go back to my former occupation. So do two other medical doctors I have previously consulted with.

The question specifically I would like you to answer is this:
Could a return to strenuous activities such as previously discussed, aggravate or cause further injury to my foot?
A Yes or No answer would be satisfactory at this time, as you have already answered my question in good detail already.

Thank you
Answered by Dr. Mukesh Tiwari 2 hours later

No, you should not return to strenuous activity at this stage.

Hope this will help you.


Above answer was peer-reviewed by
Follow-up: Fallen, MRI showed bruises on cupid bone. Pain aggravates by walking. Relief with air cast boot. Treatment? 5 hours later
I understand your answer 'No' I shouldn't return to that work. But my question was -

Could a return to strenuous activities such as previously discussed, aggravate or cause further injury to my foot?

In other words why? If the above statment is correct it may hurt my foot the answer would by YES?

I need to explain why I'm not returning to work. Ie it may make my injury worse. Please help me with the reasons from a medical standpoint.

Thanks for your help
Answered by Dr. Mukesh Tiwari 1 hour later

I can understand your concerns.

Cuboid is main bone of foot; it is a pillar for lateral column of foot. This bone articulate with calcaneum bone which takes part in bearing weight of foot. So in case of problem with cuboid as you put your weight on foot there is increase pressure over cuboid (it means a diseased bone is compressed more). So if you continue to involve with strenuous activity then there are chances that you may have damage your joints at foot.

I hope this will help you. Let me know if you need further clarifications

With best wishes.
Above answer was peer-reviewed by
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