1421 - Isolated Cuboid Fracture in a 32-Year-Old Jiu-Jitsu Athlete

We describe the etiology and clinical progression of a cuboid fracture in a 32-year-old jiu-jitsu athlete, who initially presented to the sports medicine physiatrist with 4 weeks of lateral foot pain after performing a sparring maneuver. The patient was followed in an outpatient setting. The exam was significant for decreased sensation in the lateral foot, tenderness to palpation around the base of the 5th metatarsal and cuboid, and a positive hop test in the left foot. Foot x-rays, ultrasound, and magnetic resonance imaging confirmed an oblique left cuboid fracture, and repeat x-ray imaging was performed to assess and monitor the patient’s fracture healing. The patient was instructed to wear a CAM boot while ambulating, receive gentle physical therapy, and continue a home exercise program.

Discussions:

The patient’s pain significantly improved with physical therapy, modified activity, and using a CAM boot while ambulating. Repeat imaging demonstrated stable alignment and continued healing as anticipated. However, he has some residual pain with higher-impact activities, and a discussion was had on trialing extracorporeal pulse activation therapy (EPAT), which the patient is considering as an adjunctive treatment option. It is to be determined if this treatment will have a significant effect on the continued healing and pain relief of this patient's fracture, as there have been some associations between the use of EPAT in promoting the healing of acute fractures and preventing non-union; however, further randomized controlled trials need to be performed to support this claim further.

Conclusions: Despite the rarity of cuboid fractures secondary to repetitive mechanical stress injuries, cuboid fractures should be considered and listed as a differential diagnosis in patients who report lateral foot pain, particularly after trauma or when involved in sports that place significant strain on the midfoot.