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The response to the question below was authored by Marc Mitnick DPM

non displaced cuboid fracture - 7 weeks not healing

twisted foot running on 10/13. went to ER as was in great pain. xrays negative for fracture. week later went to podiatrist still in pain and got mri. radiologist said stress reaction but podiatrist thought he saw something. radiologist amended his report to say nondisplaced fracture of cuboid bone. in walking aircast boot for 7 weeks. all i've done is swim without pushing off wall and some aqua jogging. got bone stimulator off of ebay and used for 3 weeks (ran out of batteries and can no longer use). yesterday was 7 weeks since fracture 6 weeks in boot. had another mri and it said "persistent nondisplaced fracture of cuboid degree of marrow edema has improved only slightly since prior examination.


is this normal to not heal by 7 weeks since incident?
shouldn't there be some healing?
what is next step?
how much longer can i expect it to be healed?

i'm an avid runner and being in the boot is killing me. no way did i expect the mri to show non-healing

thanks for any help

RESPONSE

Hi,

I am going to go out on a limb and guess since you are an avid athlete that you are in good health and are a non-smoker. It would be nice to know how old you are.

One would think that a possible fracture in an otherwise healthy individual would be healed by now.

I am not sure I like the idea that you were swimming and doing water exercise during this time, nor do I think the bone stimulator you bought on Ebay did you any good.

What we know from the MRI is
that you might have a fracture. Reactive marrow edema is suggestive of a fracture but not definitive and since there is no real "crack" in the bone, we cannot be certain there is actually a break in the cuboid bone.

You might be dealing with a subluxed cuboid that has not "popped" back into place and that too may explain why you still have pain. An MRI is not very good at finding a displaced cuboid; a CT scan is usually better.

If you were my patient I would approach the problem this way: I would order a bone scan. If it comes back "hot" than you can assume fracture; if it does not, you may be dealing with a subluxed cuboid. (all this assumes the MRI was negative for any soft tissue damage in the surrounding area).

Quite frankly you are correct in your assumption that a possible crack in the bone should be healed by now in an otherwise healthy individual.

So, if the bone scan comes back hot then we can assume a fracture and in that case you will have to remain immobilized, but in addition I would recommend getting a real bone stimulator through your doctor; most insurances will cover them seven weeks post trauma.

If the bone scan comes back negative and there is no problems with the surrounding soft tissue, via MRI, then I would be leaning more towards a subluxed cuboid. At this point I would see about manipulating it back into place.

Hope this is helpful.

Marc Mitnick DPM
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Comments for non displaced cuboid fracture - 7 weeks not healing

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Oct 03, 2015
Rating
starstarstarstarstar 		Non-displaced fracture
by: Kimberly

Hello, My name is Kimberly and I've been in pain for 3 months now. I finally started going to the doctor about 2 months ago and it's been horrible trying to actually get an MRI done with my insurance. I got the MRI done on 10/2/2015 and went to my doctor. He said I have non-displaced fractures in my T1 and T2 with bone marrow edema.

Here is what the MRI report says exactly,
MRI of the foot delineates of the abnormal diminished T1 and increased T2 edema signal involving the shaft of image 12 sagittal image 8. There is marrow edema throughout the metatarsal shaft and there is associated cortical thickening and periosteal edema . The 2nd and 3rd and 5th metatarsals appear intact. Cuboid and cuneiform's appear normal. Plantar fascia appears normal. Flexor hallucis and flexor digitorum longus and peroneous longus are normal without tear or tendionpathy. Hallux sesamoids are normal. Inter-metatarsals soft tissues are normal.

Impression:
Tiny incomplete non-displaced fractures involving the dorsal cortical margin of the base/proximal shaft of the 1st metatarsal with associated marrow edema. CT would best define cortical and trabecular/fracture plane anatomy.
Sub-acute healing fracture of the proximal shaft of the 4th metatarsal with marrow edema and surrounding cortical thickening and bony callus.

I already had a CT done, but the doctor at the ER said that I was moving, which I know I was not, I always stay very still for things like that and that he couldn't see anything because of that. So he wasn't sure if anything was wrong. I guess my question is, it's been 3 months, why has it not healed yet on it's own? Sure I've been walking on it, but I would think it would of healed by now at least.


It would seem to me that immobilization and possibly a bone stimulator might be indicated at this point.

Marc Mitnick DPM
Dec 03, 2013
Rating
starstarstarstarstar 		cuboid bone non healing issues
by: Anonymous

thanks dr. mitnick. I am 60 year old female, very very active. run and bike for many years.
first mri on 10/23 showed: "contusion and/or stress reaction within the cuboid mostly at the distal dorsolateral aspect which is in the area of concern. there is surrounding soft tissue edema". there is other stuff but not important. subsequently my podiatrist looked at dvd of mri pics and thought he saw something and radiologist amended his mri report to write: the overall funidngs are consistent with a nondisplaced fracture of the cuboid".

I wrote previously what yesterday's mri said "persistent nondisplaced fracture of cuboid. marrow edema is still present degree of marrow edema is minimally improved".

so the mri shows fracture - you would still request a bone scan? I emailed my podiatrist and he said that I should go in a cast for 4 weeks and then have another mri. do you concur? I also have an appt. with an ortho.

I am beside myself with 8 weeks of no healing. I obviously move around in the walking cast and when I lie in bed I move my foot (invert, evert, dorsi, plantarflex to get the feet moving). maybe that is a bad thing.

so you recommend bone scan to positive identify fracture. if not a fracture, then you think it could be subloxed...........

do you think I lose the 8 weeks of time spent in the boot. does the clock start over from square one???? thanks so much

RESPONSE

Hi,
I think a bone scan would differentiate a fracture from a displaced (subluxed cuboid), as I keep in mind that your radiologist initially did not describe it as a fracture, but your podiatrist interpreted it as a fracture. The only caveat here would be if the recent MRI is definitive for fracture.
If the bone scan is hot, then it would confirm a fracture and yes, you should probably go in a cast, non-weightbearing, as well as using a bone stimulator (new one).

If the bone scan is negative, then I am leaning more towards a displaced cuboid and attempting to manipulate it back into place would be indicated.

Now at age 60 if your bones exhibit osteoporosis that may slow down the healing of a fracture, you do not smoke so that is not an issue.

I think that is about as far as I can go with your problem, from this side of the internet. I appreciate your disappointment with how long this is taking, but your best bet is to get a couple of opinions from local doctors who can physically examine you and together hopefully, will be able to resolve the issue.

Marc Mitnick DPM

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