A cuboid bone fracture is a crack or break in the cuboid bone, which is in the central foot. Most of these sorts of fractures are hairline or stress fractures, which means that the bone remains more or less in tact. Cracks are usually visible on X-rays and can cause significant pain, but there’s not usually much that can be done aside from waiting for things to heal themselves. More complete fractures, on the other hand, happen when the bone breaks into distinct pieces or otherwise separates. Casting can sometimes fix this, but due to the bone’s small size and intricate location, surgery is often required to make sure that everything heals properly.
Where it Occurs
The cuboid is one of three bones in the mid-foot, alongside the cuneiform and navicular. All three of these are situated between the metatarsals, which are the bones in the top of the foot, and the calcaneus at the heel. A cuboid bone fracture is sometimes referred to as a “nutcracker fracture” because the cuboid is often broken between the fourth and fifth metatarsals in a way that is reminiscent of a nut being cracked between the prongs in a nutcracker.
How This Sort of Injury Happens
It is relatively rare for a person to break their cuboid bone without also breaking other bones in the foot, but it can happen. This is most common in cases of direct trauma, like when something very heavy is dropped on a specific part of the foot; the same thing can happen when the foot twists or bends back on itself awkwardly and pressure is concentrated in a specific place.
More often, cuboid fractures are accompanied by several other broken bones in the foot or ankle. Concurrent injury to the foot’s tendons and ligaments is also common. Most of the time all of these can be treated together, but a lot depends on the specifics of the injury and the severity of the cracks and breaks.
It’s usually somewhat difficult to isolate specific cuboid fracture symptoms since the bone is such a small part of the foot. The cuboid bone sits off to the side, though, which means that pain, tenderness and bruising along the outer edges of the foot are some of the best indicators that something is wrong. In most cases the first symptom is an inability to bear weight on the injured foot. The foot may also look deformed or contorted if there are multiple fractures.
An X-ray or computer tomography (CT) scan is one of the best ways to definitively diagnose cuboid bone fractures, as these technologies allow medical professionals to see inside the foot to get a sense of what the bone structure actually looks like. Using scanning technology makes things more precise, and may also highlight other injuries to surrounding bones or ligaments.
It’s also possible for well trained practitioners to make a diagnosis based on touch and visual presentation. This sort of external conclusion can usually identify the cuboid as the center of pain, but works best when the bone has been crushed or completely broken. Hairline fractures and cracks are harder to see from the outside, and may be overlooked or misdiagnosed as simple soreness or strain.
Typical Treatment Options
Treatment usually depends on how severe the fracture is, as well as how many — if any — other bones are affected. For basic cracks and stress fractures, immobilization and rest are often the best courses of action. People may get a cast or a stiff brace to help keep the bones still and in place, and most of the time things will heal themselves in anywhere from four to six weeks.
The more serious the injury, the more invasive and intensive the treatment usually needs to be. Bones that have separated into two or more defined pieces often need to be reset by an orthopedist, which usually involves manual realignment and can be very painful. This process is often called an open reduction internal fixation, or ORIF.
Surgery may also be required, particularly for bones that have been crushed or injuries that involve muscles and ligaments, too. Both surgery and ORIF are usually followed by a period of immobilization in a cast followed by physical therapy to help the patient regain proper foot function and strength.