Question
QUESTION: hello,
I suffered an avulsion fracture on the cuboid bone 13 weeks ago and severely sprained my ankle. I have since been diagnosed with chronic ankle instability and my consultant wants to perform a brostrom procedure. I am still getting significant pain in the cuboid/5th metatarsal area and cant weight bare for long periods (I am an ITU nurse). I am having a fluoroscopy guided injection in the area today so I hope it will help. I am quite reluctant to go ahead with surgery as I will be out of action for some time, however my foot does not seem to be getting better. Should I give it more time or should I go ahead with the surgery. I know if I go over on it again I will be in trouble. Only plain x-rays have been taken and he has refused me physiotherapy as he says it wont help??!! I'm finding it hard to make the decision and am hoping it will return to normal in time, or will it if I damaged it badly?
Any help would greatly be appreciated, thank for your time S.

ANSWER: The therapy would help promote any additional healing. The injection will help with the pain and may help with any scarring that may be causing some pain.I think you mean an avulsion fracture of the 5th metatarsal.Those are usually the ones that are slow healers and cause pain. Make sure your pain is not in that area and don't inject around the healing fracture site-it will undo some of the healing.You may need to wear a cast boot if the fracture is healing slow and internal fixation if not healing
Get the injection and possibly a second opinion.
I like simple repairs of the ankle ligament and capsule-similar to the bronstrom-but without too much plication or tightening of the ligaments. The Brostrom is a good procedure if done right---but I think your symptoms are related to the 5th metatarsal avulsion fracture. You should have been in a high rise removal cast boot at the minimum. Everytime you walk you trigger the peroneal longus tendon which pulls at the the fracture.
Hope this helps
Good Luck
Dr George Tsatsos---a Chicago Podiatrist
AnkleNFoot.com
Not Med Advice-Just Info for All


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

QUESTION: thank you for your swift reply,
I had the injection this afternoon which was fine, he said it would take a couple of weeks to work. It was definitely the cuboid that was fractured I was told it's very rare to pick them up in plain x-ray, so I suppose I was one of the lucky ones. They put me in an aircast boot for 4 weeks which was weight baring from the start. I was told then to wean myself out of it and get back to normal, it took 10 weeks to get back to work, and like I said I cant stand for long periods, making working very difficult. Does the cuboid bone take a long time to heal? Should I still go for the brostrom even though i get little pain from the ligament? My predicament is that I know if I go over on it again it wont be good so should I get it as a preventative measure? I'm so confused!!
Thanks again S

ANSWER: The cuboid takes a long time. Get cork and leather orthotics (orthoses) with possible soft topcovers--the most expensive and custom made to less expensive over the counter arch supports.The custom ones will work much better. Continue to wrap the foot to above the ankle. If you are overweight-now is a good time to lose some weight. Do range of motion exercises of the calcaneocuboid and metatarsal joints before and after work. When it hurts-if you can stand it-immerse in ice water up to 15 minutes. Take oral anti-inflammatories max dose for a week then decrease.
Unless you are an athlete-skip the bronstrom and do strengthening exercise and get a lightweight ankle brace. Surgery is usually done if you are athletic and/or now the ankle turns in easily
Good Luck Again
Dr George Tsatsos-Chicago Podiatrist
Board Certified Foot & Ankle Surgery & Orthopedics
NOT ADVICE_JUST INFO  


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

QUESTION: That's great will do that. I'm not overweight. I do like to dance not professional anymore! Thanks for your help S.

Answer
My advice still holds
Since you are not overweight, then it is the standing and physical activity. Good supportive orthotics should make a difference.
A well placed cortisone injection into the calcaneocuboid joint may also help.

Good Luck Again
Dr George Tsatsos-Chicago Podiatrist
Board Certified Foot & Ankle Surgery & Orthopedics
NOT ADVICE_JUST INFO