Detachment of a bone fragment of the cuboid bone. Treatment of fractures of the cuboid and navicular bones

With a fracture of the navicular bone without displacement of fragments impose a plaster bandage type "boot" in moderate plantar flexion of the foot. A special metal arch support is cast into the plantar part of the bandage to prevent flattening of the arch of the foot. The duration of immobilization is up to 8 weeks. Dosed load on the foot is allowed after 3-4 weeks. In the process of treatment, X-ray control is periodically carried out.

With fractures of the navicular bone with displacement of fragments an attempt should be made to compare them manually under anesthesia or intraosseous anesthesia. The patient lies on the table, the leg is bent at the knee joint to a right angle. One assistant holds the heel, the other pulls the toes forward, flexes the foot and performs an eversion. In this case, the space between the sphenoid bones and the head of the talus increases. At this point, you need to press thumb on a protruding fragment of the scaphoid, which in most cases is set into place. After the control radiography, a plaster bandage of the "boot" type is applied.

In more difficult cases of fracture-dislocation of the navicular bone with a large displacement of fragments, reduction is performed using the apparatus designed by Cherkes-Zade et al. One needle is passed through the calcaneus, the other through the heads of the metatarsal bones. After stretching with pressure on the displaced fragment of the navicular bone, its reduction is easily achieved.

Sometimes compression fractures of the scaphoid with dislocation of the foot in the Chopard joint present significant difficulties for conservative treatment. In such cases, open reduction is indicated.

With multi-comminuted fractures of the navicular bone with a large displacement of fragments that are not amenable to conservative treatment, arthrodesis should be performed between the navicular bone and the head of the talus and the posterior surfaces of the three cuneiform bones. This intervention can lead to a shortening of the inner edge or part of the foot and the omission of the inner arch - flat feet. Some authors suggest restoring balance by resection of part of the navicular bone. In our opinion, it is more perfect to use a bone graft after refreshing the articular surfaces of the bones surrounding the navicular bone. A bone graft from the tibia can be used. During the operation, a bone groove is formed in the heads of the talus and I sphenoid bones, where the bone graft is inserted; it is possible to fill the defect with a spongy bone taken from the iliac wing.

The navicular bone should not be removed even if it is significantly damaged, since the possibility of fusion is not excluded during prolonged plaster immobilization. Removal of the navicular bone may further affect the statics of the foot in the form of a pronounced flattening of the sole and valgus curvature of the forefoot. In severe injuries of the navicular bone, arthrodesis is performed along the line of the Chopard joint with bone grafting. After the operation, a blind plaster bandage is applied to the knee joint with a metal arch support for a period of 3 months. Loading the diseased limb in such a plaster cast begins after 5-6 weeks. After removal plaster cast prescribe physiotherapy exercises, massage, swimming in the pool or baths. In the future, patients should wear orthopedic shoes for at least 6-8 months or arch support insoles for up to a year or more.

Fractures of the sphenoid bones. All cuneiform bones, except for the first, articulate on all sides with other bones of the foot. Therefore, isolated fractures are extremely rare. More often, fractures are combined with dislocations of the metatarsal bones in the Lisfranc joint. This damage is explained by the fact that the anterior articular surfaces of the sphenoid bones articulate with the posterior articular surfaces of the first three metatarsal bones, and the line passing between these bones is inner part Lisfranc joint.

Of the three cuneiform bones, I is most often damaged, located at the inner edge of the foot and less protected from external influences. Nevertheless, fractures of all the sphenoid bones at the same time are possible.

Fractures of the sphenoid bones, intra-articular and are classified as severe foot injuries. In most cases, they result from compression or crushing of the sphenoid bones between the metatarsal and navicular bones. Basically, these fractures are the result of direct trauma - the fall of heavy objects on the back of the foot. The prognosis of such fractures is favorable, but sometimes prolonged pain remains. In the elderly, the development of arthrosis in the joints of the foot should be expected.

The technique of X-ray examination and the method of recognition of fractures of the sphenoid bones is the same as for fractures of the navicular bone. The difference lies in the fact that the imposition of II and III sphenoid and metatarsal bones articulating with them often simulates a fracture line. A slight change in the direction of the x-rays avoids overlapping contours.

In case of fractures of the sphenoid bones without a significant displacement of the fragments, the imposition of a circular plaster bandage of the "boot" type is indicated. A metal arch support is cast into the plantar part of the bandage to prevent the development of post-traumatic flat feet.

Walking is prohibited for 7-10 days, then a dosed load on the injured limb is allowed. The plaster bandage is removed after 5-7 weeks and physiotherapy exercises, massage, baths are prescribed. It is recommended to wear shoes with an orthopedic cork insole throughout the year. Ability to work is restored after 8-10 weeks.

In case of fractures of the sphenoid bones with displacement of fragments, when conservative measures do not give the desired effect, an operation is performed with transarticular fixation with a metal Kirchner wire.

The prognosis for fractures of the sphenoid bones is generally favorable; however, pain is often observed, which can last a long time.

Cuboid fractures. Cuboid is the key to the outer arch of the foot and breaks very rarely, despite the fact that it is located in the area of ​​​​the outer part of the foot. Practically, a cuboid fracture occurs as a result of direct trauma. In rare cases, the cuboid bone breaks into several fragments when it is compressed between the calcaneus and the bases of the IV and V metatarsal bones. Fracture of the cuboid bone can be caused by the fall of weight on the foot in the position of its sharp flexion. Most often, the cuboid fracture line runs in the sagittal or slightly oblique direction. The outer fragment has a protrusion, which is limited in front by a groove for the long peroneal muscle.

Comminuted fractures of the cuboid bone often combined with fractures of other bones of the foot, in particular with fractures of the base of the metatarsal bones, III sphenoid and navicular bones. Isolated cuboid fractures are extremely rare. When diagnosing a cuboid fracture, one should not forget about the existence of additional bones that can be mistaken for an avulsion fracture of the cuboid bone. Avulsion of bone tissue from the cuboid bone is observed quite often with a severe injury in the midfoot area.

X-ray examination of the cuboid bone is most informative in direct projection.

Like sphenoid fractures, cuboid fractures are usually not accompanied by a large displacement of fragments. Therefore, the treatment is mainly reduced to the immobilization of the foot with a plaster bandage of the "boot" type, into the plantar part of which a special metal arch support is cast.

Walking is prohibited during the first 5-7 days, then a dosed load on the injured limb is allowed. A plaster bandage is applied for 4-6 weeks, after which physiotherapy exercises, massage, swimming in the pool or baths are prescribed. Orthopedic shoes with cork insoles should be worn for a year. Ability to work is restored after 6-8 weeks.

Often, with multi-comminuted fractures, pain remains for several months, especially with long walking. In such cases, it is necessary to remove small fragments promptly. If a comminuted fracture of the cuboid bone is accompanied by fractures of other bones of the foot, then surgical treatment is recommended.

A broken foot is one of the most common types of fracture.

The huge number of bones in the foot, the enormous loads that these bones must withstand daily, the lack of minimal knowledge about the prevention of foot fractures make this complex anatomical formation especially vulnerable.

Anatomical excursion

Foot - the lower part of the lower limb, which has a vaulted structure and is designed to absorb shocks that occur when walking, jumping and falling.

The feet perform two main functions:

• firstly, they hold body weight;
• secondly, they provide the movement of the body in space.

These functions determine the structural features of the feet: 26 bones in each foot (a quarter of all the bones in the human body are located in the feet), the joints connecting these bones, a large number of powerful ligaments, muscles, blood vessels and nerves.

The joints are inactive, and the ligaments are elastic and high-strength, so dislocation of the foot occurs much less frequently than a fracture.

Since we are talking about fractures, let's turn Special attention on the bone skeleton of the foot, which consists of the following bones:

1. Heel. It is the largest bone in the foot. It has the shape of a complex three-dimensional rectangle with depressions and protrusions, to which muscles are attached and along which nerves, vessels and tendons pass.
2. Ram (supracalcaneal). It stands in second place in size, is unique in the high percentage of the articular surface and in that it does not contain a single bone or tendon attachment. It consists of a head, a body and a neck connecting them, which is the least resistant to fractures.
3. Cuboid. It is located in front of the heel bone closer to the outside of the foot. Forms the arch of the foot and forms a groove, thanks to which the tendon of the long peroneal muscle can fully work.
4. Scaphoid. Forms joints with the talus and three sphenoid bones. Occasionally, the development of this bone is disturbed and the 27th bone of the foot can be observed - an additional navicular bone connected to the main cartilage. With unskilled reading of the x-ray, the accessory bone is often mistaken for a fracture.
5. Wedge-shaped. From all sides attached to other bones.
6. Metatarsal. Short tubular bones serve for cushioning.
7. Phalanges of fingers. Similar to the phalanges of the fingers in number and location (two flanks for the thumbs and three for each other finger), but shorter and thicker.
8. Sesamoid. Two very small (smaller than a pea), but extremely significant round bones, are located inside the tendons and are responsible for flexing the first toe, which bears the maximum load.

Every tenth fracture and every third closed fracture occurs in the foot (for military personnel, this figure is slightly higher and amounts to 13.8% in peacetime).

The most common foot fractures are:

• talus - less than 1%, of which about 30% of cases lead to disability;
• calcaneal - 4%, of which 83% - as a result of a jump on straight legs from a great height;
• cuboid - 2.5%;
• scaphoid - 2.3%;
• metatarsal - the most common type of injury to the foot bone.

The average duration of disability for a toe injury is 19 days. For children, such an injury is not typical, there are incomplete fractures (cracks).

At a young age, split fractures are common, after 50 years - depressed ones.

Causes of injury

Fracture of the bones of the foot can occur for several reasons:

• falling heavy objects on the foot;
• jump (fall) from a great height with landing on the feet;
• when kicked;
• when hit on the leg;
• with subluxation of the foot due to walking on uneven surfaces.

Features of fractures of different bones

Distinguish different types fractures depending on the bone that was injured.

Calcaneal fracture

The main cause of occurrence is landing on the heels when jumping from a considerable height, the second most common is swipe at an accident. Upon impact, the weight of the body is transferred to the talus, it crashes into the calcaneus and splits it into pieces.

Fractures are usually unilateral, usually complex.

A fatigue fracture of the calcaneus stands apart, the main cause of which is chronic overload of a bone that has anatomical defects.

It should be noted that the very fact of the presence of an anatomical defect does not lead to a fracture, its occurrence requires constant and fairly serious loads, therefore, such a fracture is most often observed in army recruits and amateur athletes who neglect medical examination before prescribing high loads.

Talus injury

A relatively rare fracture that occurs as a result of a fall from a great height, an accident or a blow and is often combined with injuries lumbar and other fractures (from the bones of the foot, the calcaneus usually suffers along with the talus).

Even if the vessels are not ruptured, due to their compression, the supply of nutrients to the bone is disrupted, the fracture heals for a very long time.

cuboid fracture

The main reason for the occurrence of a fracture is the fall of a heavy object on the leg, a fracture due to impact is also possible.

As is clear from the mechanism of occurrence, usually unilateral.

Fracture of the scaphoid

It is formed as a result of the fall of a heavy object on the back of the foot at the moment when the bone is in tension. A fracture with displacement and in combination with fractures of other bones of the foot is characteristic.

AT recent times Fatigue fractures of the navicular bone are noted, which used to be a rarity - this is primarily due to an increase in the number of non-professional athletes who exercise without medical and coaching support.

Sphenoid bone injury

The consequence of a heavy object falling on the dorsum of the foot and crushing the sphenoid bones between the metatarsal and scaphoid bones.

This mechanism of occurrence leads to the fact that fractures are usually multiple, often combined with dislocations of the metatarsal bones.

Metatarsal fractures

The most frequently diagnosed, are divided into traumatic (arising from a direct blow or twisting

feet) and fatigue (caused by foot deformity, prolonged repeated loads, improperly selected shoes, osteoporosis, pathological bone structure).

A stress fracture is often incomplete (it does not go beyond a crack in the bone).

Injury of the phalanges of the fingers

A fairly common fracture, usually caused by direct trauma.

The phalanges of the fingers are not protected from external influences, especially the distal phalanges of the first and second fingers, which protrude noticeably forward compared to the rest.

Almost the entire spectrum of fractures can be observed: there are transverse, oblique, T-shaped, comminuted fractures. Displacement, if observed, is usually on the proximal phalanx of the thumb.

It is complicated, in addition to displacement, by the penetration of infection through the damaged nail bed, and therefore requires sanitization of the fracture site even if the fracture at first glance seems closed.

Sesamoid fracture

Relatively rare type of fracture. The bones are small, located under the end of the metatarsal bone of the big toe, usually broken due to sports activities associated with a large load on the heel (basketball, tennis, long walking).

Sometimes it is easier to remove sesamoid bones than to treat a fracture.

Symptoms depending on location

Symptoms of foot fractures, regardless of type:

• pain,
• edema,
• inability to walk
• bruising in the area of ​​injury
• change in the shape of the foot with a fracture with displacement.

Not all symptoms may be observed, the severity of the signs depends on the specific injury.

Specific features:

• with a talus fracture: displacement of the talus (noticeable on palpation), pain when trying to move the thumb, sharp pain in the ankle when moving, the foot is in a flexion position;
• with cuboid and navicular fractures: sharp pain in the location of the corresponding bone, when trying to abduct or adduct the forefoot, edema occurred on the entire anterior surface of the ankle joint.

Diagnostic methods

Diagnosis usually comes down to an X-ray examination, which is performed in one or two projections, depending on the location of the alleged fracture.

If a talus fracture is suspected x-ray examination uninformative, the best diagnostic method is CT scan.

First aid

The only type of first aid for a suspected foot fracture is to ensure the immobility of the foot. It is carried out in mild cases by a ban on movement, in the rest - by imposing a tire.

Then the victim should be taken to the clinic. If swelling occurs, ice can be applied.

Therapeutic measures

Treatment depends on several factors:

• type of broken bone
• closed fracture or open;
• complete or incomplete (crack).

Treatment consists in the imposition of a plaster splint, plaster bandage, bandage or fixative, surgical or conservative treatment, including physiotherapy exercises and special massage.

Surgical treatment is carried out in exceptional cases - for example, with fractures of the sphenoid bones with displacement (in this case, an operation with transarticular fixation with a metal Kirschner wire is indicated) or with fractures of the sesamoid bones.

Recovery after injury

Recovery after an injury is achieved through special massage and exercise therapy, reducing the load on the injured limb, using orthopedic insoles, arch supports, heel pads and not wearing heels for a long period.

With fractures of the sphenoid bones, prolonged pain can be observed.

Complications

Complications are rare, with the exception of extremely rare fractures of the talus.

Foot fractures are not life-threatening. However, the quality of later life largely depends on whether the injured received treatment.

In addition, I would like to draw the attention of non-professional athletes and athletes to the fact that a thoughtless increase in loads and the use of unsuitable shoes during classes is a direct way to close your opportunity to do physical education forever.

Even a high-quality recovery after a foot injury will never allow you to return to super-saturated workouts. Prevention is always easier than cure.

Fractures of the bones of the foot often make up a tenth of all fractures. The cause of their occurrence is not only damage of a direct nature, but also unsuccessful landings on the foot, its tucking, various falls.

For fractures of the navicular or cuboid bones of the foot, it is recommended complex treatment and the corresponding rehabilitation period, since a change in the shape of any of them can lead to a violation of the shape of the entire foot and its main functions.

Bone Anatomy

There are about 26 bones in the foot, interconnected by a ligamentous-articular apparatus. It is customary to distinguish the following main departments:

• metatarsal;
• tarsal;
• phalanges of fingers.

The sphenoid and scaphoid are located in the region of the tarsus, forming this section together with the calcaneus, talus and three sphenoid bones.

The navicular bone is located closer to the inner edge of the foot. Behind it is connected to the talus bone, and in front - with three sphenoid. There is a concavity on its lower surface, and a characteristic tuberosity is noted on the outside, which is well felt through the skin.

The cuboid bone gets its name from the irregular shape of the cube. It has a connection with the navicular bone, one of the sphenoid, calcaneus and metatarsal bones (fourth and fifth). On the surface there is a noticeable furrow and irregularities.

The scaphoid and cuboid bones carry the support load when walking, taking direct part in it. A fracture of any of them entails a loss motor activity, which can persist for a long period of time, especially with the wrong treatment tactics. It is important to apply in a timely manner medical care for any injury.

Fracture of the scaphoid

Among all the causes of scaphoid fractures, the main cause is the fall of heavy objects on the outer surface of the foot.

Professional athletes suffer from such fractures due to intense contractions of the tibial muscle during exercise. This leads to the separation of the bone fragment, which is attached to this muscle.

Other reasons include:

• injuries arising from violent intense flexion in the plantar part of the foot, resulting in the clamping of the navicular bone between the areas of the sphenoid bones and the talus;
• road accident - the cause of the fracture is compression;
• unsuccessful landing after jumping or falling from a height;
• fatigue fractures - occur in ballet workers, professional athletes and gymnasts due to prolonged high loads on the foot, which entail the restructuring of bone structures.

As a result of trauma, fractures of the navicular bone in the region of its dorsal part, body or tubercle are possible. Often, bone fragments are displaced to the back of the foot.

The following symptoms are typical:

• the occurrence of pain and swelling in the area of ​​​​the proposed fracture, often extending to the ankle joint;
• bone fragments are well palpable under the skin (when displaced);
• the support function suffers, the victim can only lean on the heel;
• movements of the foot up and down and left and right are not possible.

X-ray examination helps to establish an accurate diagnosis, after which appropriate treatment is prescribed.

Important! It is necessary to differentiate the avulsion of the tubercle with the presence of a congenital accessory navicular bone, which occurs in some people and is not considered a pathology. In such a situation, X-rays of both feet are needed, since additional structures are usually found on both sides.

Cuboid fracture

The cuboid bone is not prone to fracture. This usually happens when a joint fracture with other bones of the foot is due to heavy objects falling on the foot, an unsuccessful landing, or a fall onto the legs from a height.

To characteristic symptoms include:

• pain that worsens when you try to move your feet;
• swelling from the back-inner surface of the foot;
• inability to fully lean on the foot;
• palpation reveals a characteristic deformation (indicates displacement of bone fragments).

X-rays are of decisive importance in making an accurate diagnosis.

Important! With fractures of the cuboid or scaphoid, the surrounding soft tissues. In some cases, computed tomography or magnetic resonance imaging is prescribed to identify all injuries.

Methods of treatment

When fractures of the scaphoid or cuboid bones are not accompanied by displacement of fragments, a plaster bandage (circular) is applied by a traumatologist.

It is necessary to model the lower arch of the foot. When a bandage in the form of a "boot" is applied, a metal arch support is additionally installed, which is necessary to prevent flattening of the arch of the lower limb.

When bone fragments are displaced, reposition is needed under intraosseous anesthesia or intravenous anesthesia. Dislocation and fracture of the scaphoid requires the installation of a special Circass-zade design, when one needle is passed through the calcaneus, and the other passes through the metatarsal bones (their heads).

In severe cases, surgical treatment is performed, after which it is necessary to wear a plaster cast for at least a month. To control the dynamics, x-rays are taken. It must be understood that everything bone structures in the foot are interconnected, so you need to completely restore the fracture site.

Important! In the case of multi-comminuted fractures, sometimes it is not possible to completely collect and fix all the fragments, which entails the need for partial removal of the bone and subsequent filling with a bone graft. In this capacity, the tibial area or artificial materials can act.

Possible Complications

Late appeal to medical institution or non-compliance with all the prescriptions of the attending doctor in case of a fracture of the cuboid or navicular often leads to complications.

• the appearance of lameness;
• Availability pain syndrome chronic form;
• the occurrence of flat feet or flattening of the sole;
• manifestations of valgus curvature of the forefoot;
• loss of work capacity.

At surgical treatment shortening of the foot can be a consequence, and in the most severe cases disability is often given.

To prevent the development of these complications, it is necessary to follow all the recommendations of an orthopedic traumatologist, undergo full course rehabilitation activities.

Rehabilitation

After applying a plaster cast for fractures of the cuboid or navicular bones, it is recommended to give the leg rest for a week, after which you can proceed to rehabilitation. Loads in the presence of multiple fractures are possible only after a month and a half.

Important! The main task of all rehabilitation measures is the restoration of the anatomical integrity of the foot bones, the normalization of its spring functions. This is necessary to soften the repulsion and protect the internal organs from a variety of sharp shocks in the process of walking and shaking when jumping or running.

Rehabilitation includes several activities.

Massage

It is necessary to restore full blood supply, nourish tissues and prevent the development of muscle atrophy. Performed on the most early dates until the plaster is removed from the leg. Helps relieve swelling and symptoms of pain.

It is important to massage not only the injured limb (around the plaster cast and under it), but also the healthy one, as the load increases on it.

After removing the cast, massage helps to restore leg mobility, eliminate residual manifestations of atrophy, restore muscle tone and elasticity.

Transverse and longitudinal stroking, rubbing and vibration are performed. All massage movements alternate with regular stroking.

Physiotherapy

It is carried out in conjunction with massage, helps relieve pain and swelling. The most commonly prescribed procedures are magnetotherapy, electrical stimulation, interference currents, electrophoresis and UHF.

Physical exercises while wearing a cast are necessary to improve blood circulation, exercises increase the tone of the whole body.

In this period, simple flexion and extension with the fingers, movements in the hip and knee joints, pressure on the surface of the sole with the help of a support or hands of an assistant are sufficient. Contractions of the sole muscles and walking with crutches will be helpful.

The second stage of exercise therapy is the restoration of mobility in the joints. It is necessary to return the support and spring functions of the foot, to strengthen the muscular frame. To do this, you need to perform exercises for bending the sole and unbending it, grab stuffed balls, small objects with your foot and fingers, and work on simulators. The main task of all exercises is to restore full walking.

Swimming pool

It is useful to use different walking in the water, a variety of exercises. A good effect was noticed after swimming with fins. All of the above exercises are allowed only after the removal of the cast.

Proper nutrition

It is useful to consume foods high in calcium and vitamin D. It is necessary to include fermented milk products, milk and seafood in the diet. Recommended vitamin and mineral complexes.

The final stage of all these activities is full recovery biomechanics of walking. You have to learn how to jump and run again. Strengthening the endurance of the muscles of the lower limb plays a huge role. Jumps, jumps and running exercises will be useful.

Important! All classes in the recovery period should be performed under the supervision of specialists and with their help. If pain or muscle spasm occurs, you should immediately stop and stop exercising. You need to load the injured leg gradually.

Additional activities

In addition to all of the above rehabilitation measures, after discharge from the hospital, it will be useful to undergo Spa treatment continue to eat healthy, walk and exercise regularly.

• flexion and extension of the toes;
• standing on tiptoe, followed by lowering on the heels;
• foot turns to the right and left;
• rolling the ball on the floor.

It is useful to pick up pencils and pens from the floor with your fingers or alternately stretch your foot away from you and towards you.

Necessarily prolonged wear arch support, orthopedic shoes, special insoles or orthoses. The conclusion about the full recovery is given by a traumatologist or orthopedist.

Conclusion

Fractures of the bones of the foot are always a difficult test, as they lead to impaired motor activity and interfere with daily activities.

Injuries require a fairly long therapy and an equally long recovery period. You should always be careful and try to avoid situations that can lead to a fracture. Human body- a fragile thing, so you need to protect it.

Cuboid fractures are rare. This is due to the peculiarities of the anatomical position of the cuboid bone, in which it is protected from damage by the surrounding bones.

The main types of cuboid fractures are compression and avulsion fractures.

Fractures due to insufficient bone tissue are called stress fractures and constitute the third and least common group of injuries.

The most common variant of a cuboid fracture is an avulsion fracture in the region of its outer surface.

The separation occurs in the area of ​​​​attachment of the calcaneocuboid ligament, and the bone fragment, in fact, is torn off along with it.

These fractures are best seen on radiographs or CT scans.

Often they are missed, mistaking the damage for a simple "sprain".

Patients describe the typical mechanism of injury as twisting of the foot, often with the foot tucked inward.

Clinically, with such fractures, pain will be localized along the outer edge of the foot.

Careful examination in such cases makes it possible to distinguish damage to the external ligaments of the ankle joint from an avulsion fracture of the cuboid bone.

The severity of subcutaneous hemorrhage and bruising with such fractures may be different.

Conservative treatment

The vast majority of avulsion fractures can be treated conservatively, as they are mostly non-displaced or minimally displaced.

Surgery

Surgical intervention in patients with avulsion fractures of the cuboid bone is rarely indicated.

The operation is indicated primarily for patients with clinically pronounced false joints after an avulsion fracture, in which an adequate conservative treatment, including immobilization for 8-12 weeks and modification of the shoes used.

AT similar cases it is usually sufficient to remove the unfused fragment of the cuboid bone.

Compression fractures are the second most common scaphoid fracture.

This variant of fractures occurs due to a relatively higher energy injury, most often in a fall on the foot.

These fractures are also often associated with Lisfranc injuries or other fractures/dislocations of the tarsometatarsal joints, which require special attention.

Patients usually report a history of high-energy trauma.

Shortly after such an injury, pronounced swelling of the foot most often develops. Patients with such a foot injury are usually examined very carefully, since cuboid fractures are often associated with fractures or dislocations in other parts of the foot.

All patients after a high-energy injury that led to a fracture of the cuboid bone undergo computed tomography, since combined injuries of the tarsal and metatarsal bones in such patients are also not uncommon.

Conservative treatment

Patients with isolated fractures of the cuboid bone without displacement or with minimal displacement are shown to be immobilized with a short plaster splint, which allows the possibility of loading the leg.

Upon termination of immobilization, the gypsum splint changes to an orthopedic boot and a dosed load on the foot is allowed.

The return to regular shoes is determined by the severity of the pain syndrome and residual edema, the presence of radiological signs adhesions.

Most often, patients begin to wear their usual shoes 8-12 weeks after the injury.

Surgery

The management of cuboid fractures with displaced fragments is still a matter of debate, as there is no consensus as to how significant the displacement must be in order for the fracture to be unequivocally amenable to surgical repair.

Most physicians agree that the cuboid is an important stabilizer of the lateral column (outer edge) of the foot, and changes in the length of the lateral column inevitably lead to foot deformity, flat feet, and pain.

The most common deformity due to a compression fracture of the cuboid is shortening of the lateral column, so any surgical intervention should be aimed at restoring this length of the lateral column.

There are various methods surgical interventions. In our practice, we restore the length of the lateral column by internal fixation of the fracture with plates and screws and, if necessary, bone grafting using supporting autografts from the iliac crest.

The results of treatment in all patients were good, and we use this method of treatment for any fractures of the cuboid bone, accompanied by crushing of its articular surface.

In case of multi-comminuted fractures, the only way to restore the length of the lateral column of the foot can be bridge osteosynthesis with a plate. If the fracture is accompanied by severe soft tissue injury, the only possible method treatment may be an external fixator. Regardless of the fixation technique used, all attention should be focused on maintaining the length of the lateral column of the foot, without which it is impossible to restore the normal shape and function of the foot.

Fractures due to lack of bone tissue, or stress fractures of the cuboid bone, are usually characterized by the gradual development of pain in the region of the outer edge of the foot, aggravated by physical activity.

These fractures are rare and often go undiagnosed.

Diagnosis often requires advanced imaging techniques.

Stress fractures of the cuboid bone are common in athletes.

Conservative treatment

Conservative treatment in most cases allows to achieve consolidation of a stress fracture of the cuboid bone.

Initially, the patient may be immobilized for a period of 4-6 weeks.

In the absence of load, this period is sufficient for the healing of the fracture.

At the end of immobilization, the degree of load on the leg and the level of physical activity will be determined by the patient's symptoms.

Surgery

Surgical treatment for these fractures is rarely indicated. It can be indicated, for example, when the patient still has pain despite adequate conservative treatment.

Before making a final decision about surgical treatment, we prescribe a course of high-energy shock wave therapy to our patients.

Surgical treatment may include bone grafting of the fracture area and stabilization with a compression screw. If this is also ineffective, arthrodesis of the calcaneocuboid joint may be indicated.

Video about our Traumatology and Orthopedics Clinic

Fracture of the cuboid bone of the foot is quite common. Often, when a heavy object strikes the back of the foot, a person does not experience much anxiety, in addition to pain and swelling. However, a strong blow is one of the main reasons for the formation of a bone fracture in the leg. Therefore, it is very important to seek help from a specialist as soon as possible, because treatment must be carried out by a doctor.

Possible reasons

Fractures of the bones of the foot in most cases are observed in adults and account for approximately 2-5% of total number all injuries. An interesting fact is that, according to the observations of doctors, the right leg is much more likely to undergo fractures than the left.

Since the foot is a large number small bones, damage to one of them can provoke a violation of the structure and activity of others, since they are all closely related. When carrying out treatment, one should not forget about this and use complex therapy.

The most common causes of this type of injury include:

1. A fall from a great height or a jump with a landing on the whole foot. In this case, the main impact force affects mainly marginal bones feet.
2. Sharp flexion of the foot, this can occur during sudden braking vehicle, hitting a hard object, when playing sports and increased physical exertion on the lower limbs.
3. Fall on lower part legs of a heavy object. In this case, not only a bone fracture can occur, but also damage to the skin or rupture of the ligaments.

Damage to the bone tissue of the feet occurs spontaneously, regardless of the age and gender of the person. However, there are categories of people who are at increased risk of such an injury. These include:

1. Football players, hockey players and weightlifters playing these sports carry an increased risk of foot injury.
2. Pathologies connective tissue systemic nature and increased bone fragility hereditary type. In this case, damage can occur even with the slightest physical impact on the leg.
3. Bone diseases such as osteoporosis.

Symptoms and Diagnosis

The main symptoms of fractures of any localization are:

• pronounced pain,
• the appearance of swelling in the affected area,
• hemorrhage,
• impaired motor activity of the injured limb.

However, with a more thorough examination, other signs characteristic of a cuboid fracture are noted. These include:

• acute pain, which increases with palpation and pressure on the 4th and 5th metatarsal bones,
• deformation and change in the contours of the foot,
• increased pain at the slightest attempt to move the foot.

If a fracture of the cuboid bone is accompanied by trauma to the navicular bone or their dislocation, a deformity appears, depending on the severity of the displacement of the damaged bones. In this case, the force of deflection of the forefoot forward or backward plays an important role.

When probing and pressing on all the toes on the foot, the pain intensifies, affecting all the bones of the foot.

Fractures that are accompanied by displacement, dislocation or subluxation of the bones change the contours of the dorsum of the foot. In this case, a stepwise deformation is observed. A fracture is also indicated by severe swelling and the appearance of hematomas in the affected area.

In order to determine whether there has been a fracture or a small puncture of the bone tissue, the traumatologist first of all palpates the injured area and the nearest parts of the limb. After that, the specialist asks the patient to move his fingers and the whole foot, studying the degree of difficulty in movement and paying attention to the presence of pain during a particular movement.

If the doctor has suspicions of a fracture, he necessarily directs the patient to an x-ray of the foot. It can be used to find out if a bone fracture is present, as well as to determine the presence of bone fragments and deformities.

First aid and treatment

First of all, you should fix the ankle joint in one position. This is necessary in order to prevent the movement of fragments. For these purposes, you can use various improvised means, such as sticks and boards, any fabric products. In extreme cases, you can bandage the injured leg to a healthy one.

In case the damage is middle degree severity, treatment is limited to the imposition of a plaster cast on the damaged organ. This bandage is removed after 3-6 weeks. This method of therapy is necessary in order to fully fix lower limb and prevent improper fusion of damaged bones.

In the presence of displacement, bone fragments or open damage epithelial tissues before applying gypsum, it is necessary to install fixing metal spokes.

When a tear is found or complete break ligament fibers treatment can be carried out without plaster. However, a fixing bandage is still necessary. Most often, the doctor prescribes wearing a special bandage or orthopedic shoes. In order to prevent increased physical load on the injured limb, it is recommended to use crutches.

Treatment of a fracture with drugs is necessary to eliminate pain, reduce inflammatory process and speed up the healing process. For these purposes, analgesic and anti-inflammatory drugs are used. To eliminate hematomas and relieve swelling, the doctor may prescribe special ointments and gels with absorbable effect.
As an additional therapy, the use of vitamin complexes and preparations containing calcium may be required.
It is quite difficult to unequivocally answer the question of how long a fracture heals, since it all depends on the degree of damage and the individual characteristics of the organism.

Rehabilitation and possible complications

After the end of treatment and the removal of the plaster cast, there may be slight swelling and slight pain for some time. In order to accelerate the full recovery, the patient needs a long-term rehabilitation, during which he must comply with the following recommendations:

1. Do a kneading foot and leg massage.
2. Gradually increase physical activity by doing certain exercises.
3. Attend physical therapy sessions prescribed by your doctor.
4. Use supinators. They must be worn without fail for one year. With more severe injuries, the duration can increase to several years.
5. In most cases, the traumatologist can prescribe the patient to wear orthopedic shoes. It is advisable to do this for at least 6 months.

On the foot every day it takes a lot huge pressure. The weight of the whole body should be evenly distributed among the various bones of the limb. In the event of damage to any of them, a violation of the arch of the foot occurs, which, in turn, leads to a deterioration in cushioning and support function. It is very important to detect a foot injury in a timely manner and start treating it.

A bone fracture in the foot, regardless of its nature and location, requires immediate medical attention. Lack of treatment can lead to the development of serious complications, which often cause disability.

© Y's harmony - stock.adobe.com

The legs are the support of the body, and the feet are the support for the legs. Athletes often underestimate the importance of a healthy foot and ankle in achieving optimal athletic performance, not to mention overall good health and state of health. The most unpleasant thing is that even minor injuries to the foot and ankle can have very bad long-term health consequences in the future. How foot injuries occur, what is foot dislocation and how to recognize, prevent and cure it - we will tell in this article.

The structure of the foot

The foot is a complex anatomical formation. It is based on the bone frame, represented by the talus, calcaneus, scaphoid, cuboid and sphenoid bones (tarsal complex), metatarsus and fingers.

bone base

• The talus serves as a kind of "adapter" between the foot and lower leg, due to its shape providing mobility to the ankle joint. It lies directly on the heel bone.
• The calcaneus is the largest of the foot bones. It is also an important bone landmark and the place of attachment of the tendons of the muscles and the aponeurosis of the foot. In functional terms, it performs a supporting function when walking. Anteriorly in contact with the cuboid bone.
• The cuboid bone forms the lateral edge of the tarsal part of the foot; the 3rd and 4th metatarsal bones directly adjoin it. With its medial edge, the described bone is in contact with the navicular bone.
• The navicular bone forms the medial portion of the tarsal foot. Lies anterior and medial to the calcaneus. In front, the navicular bone is in contact with the sphenoid bones - lateral, medial and middle. Together they form the bony support for the metatarsal bones.
• The metatarsal bones belong in shape to the so-called tubular bones. On the one hand, they are motionlessly connected to the bones of the tarsus, on the other hand, they form movable joints with the toes of the foot.



© rob3000 - stock.adobe.com

There are five toes, four of them (from the second to the fifth) have three short phalanges, the first - only two. Looking ahead, let's say that the toes have an important function in the walking pattern: the final stage of pushing the foot off the ground is only possible thanks to the first and second toes.



© 7activestudio - stock.adobe.com

Ligament apparatus

The listed bones are strengthened by a ligamentous apparatus, they form the following joints among themselves:

• Subtalar - between the talus and calcaneus. It is easily injured when the ankle ligaments are sprained, with the formation of subluxation.
• Talon-calcaneal-navicular - around the axis of this joint, it is possible to perform pronation and supination of the foot.
• In addition, it is important to note the tarsal-metatarsal, intertarsal and interphalangeal joints of the foot.



© p6m5 - stock.adobe.com

The most significant for the formation of the correct arch of the lower leg are the muscles located on the plantar side of the lower leg. They are divided into three groups:

• outdoor;
• internal;
• medium.

The first group serves the little finger, the second group - the thumb (responsible for flexion and adduction). The medial muscle group is responsible for flexing the second, third, and fourth toes.

Biomechanically, the foot is designed in such a way that, with the right muscle tone, its plantar surface forms several arches:

• external longitudinal arch - passes through a mentally drawn line between the calcaneal tubercle and the distal head of the fifth phalangeal bone;
• internal longitudinal arch - passes through a mentally drawn line between the calcaneal tubercle and the distal head of the first metatarsal bone;
• transverse longitudinal arch - passes through a mentally drawn line between the distal heads of the first and fifth metatarsal bones.

In addition to muscles, a powerful plantar aponeurosis, mentioned a little above, takes part in the formation of such a structure.



© AlienCat - stock.adobe.com

Types of dislocations of the foot

Dislocations of the foot can be divided into three types:

Subtalar dislocations of the foot

With this type of foot injury, the talus remains in place, and the calcaneal, navicular and cuboid adjacent to it, as it were, diverge. In this case, there is a significant traumatization of the soft tissues of the joint, with damage to the blood vessels. The joint cavity and periarticular tissues are filled with an extensive hematoma. This leads to significant swelling, pain and, which is the most dangerous factor, to disruption of blood delivery to the limb. The latter circumstance can serve as a trigger for the development of foot gangrene.

Dislocation of the transverse tarsal joint

This type of foot injury occurs with a direct traumatic effect. The foot has a characteristic appearance - it is deployed inwards, the skin, along back side feet, stretched, On palpation of the joint, the scaphoid bone displaced inwards is clearly felt. Edema is expressed as significantly as in the previous case.

Dislocation of the metatarsal joint

A fairly rare injury to the foot. Most often occurs with direct injury to the anterior edge of the foot. The most likely mechanism of injury is an elevated landing on the balls of the toes. In this case, the first or fifth phalangeal bones, or all five at once, can be displaced in isolation. Clinically, there is a step-like deformity of the foot, edema, inability to step on the foot. Significantly hampered voluntary movements of the toes.

Dislocations of the toes

The most common dislocation occurs in the metatarsophalangeal joint of the first toe. In this case, the finger moves inward or outward, with simultaneous flexion. The injury is accompanied by pain, significant pain when trying to push off the ground with an injured leg. Wearing shoes is difficult, often impossible.



© caluian - stock.adobe.com

Signs and symptoms of a dislocation

The main symptoms of a dislocated foot are:

• Pain, which occurs abruptly, immediately after the impact of a traumatic factor on the foot. At the same time, after the cessation of exposure, the pain persists. Strengthening it occurs when you try to lean on the damaged limb.
• Edema. The area of ​​the damaged joint increases in volume, the skin is stretched. There is a feeling of fullness of the joint from the inside. This circumstance is associated with concomitant trauma of soft tissue formations, in particular, blood vessels.
• Loss of function. It is impossible to make an arbitrary movement in the damaged joint, an attempt to do this brings significant pain.
• Forced position of the foot- part of the foot or the whole foot has an unnatural position.

Be careful and attentive! It is impossible to distinguish a dislocation of the foot from a sprain and fracture of the foot visually without an x-ray machine.



© irinashamanaeva - stock.adobe.com

First aid for dislocation

First aid for dislocation of the foot is the following algorithm of actions:

1. The victim must be laid on a comfortable flat surface.
2. Next, you should give the injured limb an elevated position (the foot should be above the knee and hip joints), placing a pillow, jacket or any suitable improvised means under it.
3. To reduce post-traumatic edema, you need to cool the injury site. For this, ice or any product frozen in the freezer (for example, a pack of dumplings) is suitable.
4. When damaged skin it is necessary to apply an aseptic bandage to the wound.
5. After all the actions described above, it is necessary to deliver the victim as soon as possible to a medical facility where there is a traumatologist and an X-ray machine.

Dislocation treatment

Treatment of a dislocation consists in the procedure of repositioning the leg and giving it a natural position. Reduction can be closed - without surgical intervention, and open, that is, through an operational incision.

It is impossible to give any specific advice on how and how to treat dislocation of the foot at home, since there is no way to do without the help of an experienced traumatologist. Once the dislocation has been corrected, he can give you some advice on what to do if your foot is dislocated so that you can get back on your feet as quickly as possible.

After the reduction procedures, a fixing bandage is applied, for a period of four weeks to two months. Do not be surprised that when fixing the lower leg, the splint will be applied to the lower third of the thigh - with fixation of the knee joint. This is necessary condition, since the process of walking with a fixed ankle is very dangerous for the knee joint.

© Monet - stock.adobe.com

Recovery after a dislocation

After immobilization is removed, the process of rehabilitation begins - the gradual inclusion of the muscles of the immobilized limb in the work. You should start with active movements, but without relying on the injured limb.

To restore bone density at the site of injury, you need to walk a small distance every day, gradually increasing it.

For a more active restoration of limb mobility, we offer several effective exercises. To perform them, you will need a cuff with a fixation ring and a strap for fastening in the area of ​​the Achilles tendon. We put the cuff on the projection area of ​​the metatarsal bones. We fix the strap through the Achilles tendon slightly above the level of the heel. We lie down on the mat, put the legs on the gymnastic bench. Three options follow:

In addition to the exercises described for developing the foot after an injury at home, you can use other methods and improvised means: roll a ball with your foot, perform backbends with a towel, and so on.

cuboid syndromeis a condition caused by damage to the joint and ligaments surrounding the cuboid bone. The cuboid bone is one of the bones in the foot.

Cuboid syndrome is accompanied by pain on the side of the foot from the side of the fifth (small) toe. Often the patient feels pain in the middle of the foot or at the base of the fourth and fifth toes.

Cuboid syndrome is the result of partial subluxation of the transverse tarsal joint. This is observed after a sudden injury or excessive stress on the joints of the foot.

Cuboid Syndrome - Symptoms

Cuboid syndrome causes pain on the side of the foot. The pain may appear suddenly or develop gradually.

Symptoms of cuboid syndrome

• pain on the lateral side of the foot (from the side of the fifth toe);
• the pain may be sharp;
• very difficult to jump;
• possible swelling;
• pain may increase when standing on the heels;
• decreased range of motion of the foot or ankle joint;
• sensitivity in the lower part of the foot;
• lower back pain.

Cuboid Syndrome - Causes

Dancers and athletes are at the highest risk of developing cuboid bone syndrome.

The most common causes are overuse or injury. Injuries usually develop after long periods intense activity such as running.

The injury that leads to cuboid syndrome is an ankle inversion sprain. A study found that 40% of people with ankle sprains can develop the condition.

Cuboid syndrome is also common in people with adducted legs, which means that their feet turn inward when they walk.

Other factors that cause this syndrome:

• playing sports such as tennis;
• climbing stairs;
• ill-fitting shoes;
• running on uneven surfaces.

Cuboid Syndrome - Diagnosis

The foot is a complex, flexible and durable part of the body. It contains about 100 muscles, ligaments and tendons, 28 bones and 30 joints. The complex structure of the foot and the nonspecific nature of pain in cuboid syndrome make it difficult to diagnose. Sometimes x-rays or magnetic resonance imaging (MRI) show no signs of the condition, even if acute pain is present. Cuboid syndrome can mimic symptoms of other foot conditions, such as a fracture or heel spurs.

Cuboid bone syndrome can develop at the same time as a fracture in another part of the foot. However, fractures of the cuboid bone itself are rare. To make a diagnosis and choose the most effective treatment, the doctor will conduct a thorough clinical examination and study the history of the disease in detail.

Cuboid bone syndrome - treatment

Treatment for cuboid syndrome begins with rest and reduction or elimination of activity.

Additional treatments include:

• using a pillow to stabilize the joints of the foot;
• wearing orthopedic shoes;
• taking anti-inflammatory drugs to reduce pain and swelling;
• deep massage of the calf muscles.

The length of time it usually takes to recover from cuboid bone syndrome depends on many factors, including:

• how long ago the person had the injury;
• whether it was caused by an acute injury or developed over time;
• whether it developed as part of another injury, such as a foot sprain.

If the initial injury was minor, most people begin to feel relief within a few days. However, if a person has other injuries, such as a foot sprain, recovery can take up to several weeks.

Therapeutic exercise (PT) can play an important role in ensuring full recovery.

exercise therapy includes:

• strengthening the foot;
• stretching the muscles of the foot and lower leg;
• balance exercises.

Literature

1. Hagino T. et al. A case of cuboid bone stress fracture in a senior high school rugby athlete //Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology. - 2014. - T. 1. - No. 4. - S. 132-135.
2. Martin C., Zapf A., Herman D. C. Cuboid Syndrome: Whip It Good! //Current sports medicine reports. - 2017. - T. 16. - No. 4. - S. 221.
3. Patterson S. M. Cuboid syndrome: a review of the literature // Journal of sports science & medicine. - 2006. - T. 5. - No. 4. - S. 597.