fractured cuboid

by Stephanie
(West Stewartstown nh)

I have a question on my cuboid fracture. I was seen by an orthopedic and he said i have like a bone bruise fracture on the cuboid bone. The problem that i am having is more pain and swelling my foot and it is a purple color. Its been six weeks. Now the pain is under the ball of my foot too, and radiates to the side of the foot, the pain gets worse and i cant sleep at night. The orthopedic told me to wear the walking boot only when i use my crutches and too elevate my leg. Its been getting worse. Can you tell what you think i should do.

RESPONSE

Hi Stephanie,

Obviously, without the luxury of being able to examine you, I cannot make a diagnosis as to why you are having more pain instead of less pain as time passes.
However, in cases like this where the pain is out of proportion to the injury and is getting worse rather than better as time passes, I am always concerned about the possibility of what is known as Complex Regional Pain Syndrome or CRPS. This is basically a condition where there is a short circuiting of the nerves in your foot and they are constantly "misfiring" giving you the pain that you are experiencing.
Now, I am making certain assumptions here. One, is that you have been wearing your walking cast for the whole period of time, as in many cases CRPS occurs primarily in women who have had their leg (or arm) immobilized for a prolonged period of time. I am also making the assumption that you are in good health and that both your arterial circulation (the blood coming down to your foot) and your venous circulation (the blood going back to your heart) are both normal. I am also assuming you have not been on your bad foot for prolonged periods of time and that you are not diabetic.
Your doctor may be entirely correct in his evaluation of why you have more pain and your foot is discolored as he is actually able to examine you, but I think the prudent move would be to at least mention the possibility of CRPS to him.
Unfortunately, there are no tests that confirm whether a person is suffering from CRPS, but rather the diagnosis is made on clinical grounds. Furthermore, the diagnosis is usually made by a neurologist or even anesthesiologist who specializes in pain management as CRPS is routinely missed by many doctors.
I bother to even mention all this because on the chance that CRPS is what you are suffering from, if it is not properly diagnosed and aggressively treated, it can become a devastating problem. Chronic pain that just worsens over time.
So, as I just stated, mention this to your doctor and let he or she decide if you should be worked up for this possibility. You can read more about it here.

Marc Mitnick DPM
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