Question
QUESTION: Dr. Johnston, Somehow I have injured the cuboid bone in my left foot. Saw an Ortho Dr. and had X-ray which showed only  previous injury where this foot was broken about 10 years ago. Had an MRI 1 week later and it showed pronounced dorsal soft tissue edema and Loculated? fluid. Also slight edema within the Cuboid bone which may relate to stress Phenomena? Early stress fracture not excluded but unlikely. I was told to use crutches, air boot, and no weight bearing, come back in 5 to 6 weeks.Do you think I need another MRI?Thanks, Barbie.

ANSWER: Barbara,

Another MRI would most likely not show any new changes.  Using the air boot will offload the foot to give the area adequate time to heal.  From my experience, edema in the cuboid is consistent with either a bone contusion (bruise) or stress fracture.  Either way, they are treated the same.  If you continue having pain 4-6 months after the initial MRI, then I would definitely consider repeat.  Also insurance usually won't cover an MRI if you had a previous MRI for the same problem within a certain time period.  Hope this helps, good luck.

Sincerely,
Dr. Leslie Johnston, DPM

Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page


---------- FOLLOW-UP ----------

QUESTION: Dr. Johnston, Thanks so much for taking the time to answer my question. However, everything else I've found is calling this a stress fracture and saying that it should be casted. Also, the pain is the same as before, when I injured it 10 years ago. I'm worried about a vascular necrosis. Will this heal without a cast if it is a stress fracture? Thanks,Barbie

Answer
Barbie, whether being placed in a fiber-glass cast or a boot, the treatment remains the same.  Offloading the area of injury is key.  If the area of pain is within the same spot you damaged 10 years ago and there is concern for avascular necrosis, then I would consider ordering a bone scan rather than an MRI.  A bone scan will show a "cold spot" on the imaging indicative of AVN.  It is also a good alternative to ordering a repeat MRI.  Stress fractures can absolutely heal without casting.  I rarely place a patient in a cast for a stress fracture and I don't know any other physician that does otherwise.  Cam-walker boots are the standard alternative for casts.  They're easier for patients and have less complications associated with them such as leg blood clots.  I instruct patients to be minimal weightbearing in the boot with a stress fracture and use crutches until adequate healing is noted on xray.  If I'm concerned about AVN, then I also suggest using a bone stimulator to increase vascularity to the bone.  Discuss this matter with your doctor about possibly ordering a bone scan or getting a bone stimulator to help the healing potential.  Please let me know if you need anything else.

Sincerely,
Dr. Leslie Johnston, DPM

Tampa, FL
Advanced Podiatry

http://www.thetampapodiatrist.com
http://tampafootandanklepain.blogspot.com/
http://www.tampacryosurgery.com
http://katzpodiatristtampa.blogspot.com
http://twitter.com/TampaPodiatrist
http://www.notoenailfungus.com
http://www.vibranttampatoenails.com  
Advanced Podiatry Facebook Page