Lateral ankle sprain with cuboid syndrome in a secondary school student-athlete

Background: Lateral ankle sprains (LAS) are one of the most common injuries in secondary school student-athletes. Cuboid syndrome (CS), a mild alteration to the arthrokinematics or congruency of the cuboid sometimes caused by improper or ill-fitting footwear, may be overlooked due to its similarities to LAS. Many secondary school student-athletes do not wear proper footwear for their foot size or type and may often be a secondary cause of CS after an inversion mechanism. Additionally, weakness or overuse of peroneus longus muscle is also thought to play a role in CS due to its insertion.

Case Presentation: The patient is a white 18-year-old male basketball student-athlete with a history of LAS. During practice he landed on another player's foot, resulting in pain, tenderness and swelling over the lateral right talocrural joint that extended to the cuboid and midfoot. He reported hearing and feeling a pop at the time of injury. X-rays and orthopedic tests were performed, and results indicated a Grade II LAS. The patient continued to present with lateral midfoot tenderness, restricted dorsiflexion, and discomfort during the push-off phase of gait. Localized swelling was noted surrounding the cuboid. Due to this prolonged discomfort, further special tests were performed. The dorsal-plantar cuboid shear test was positive, and produced an audible cavitation with immediate pain reduction. After the test, the patient was then able to walk without antalgic gait. While pain returned occasionally, joint mobilizations were performed and rehabilitation emphasized peroneal strengthening in addition to various other strength and agility work. The patient was able to return to play within 20 days.

Conclusions: Additional orthopedic testing is useful in LAS to rule out CS if pain persists and is located below the talocrural joint or within the midfoot. Strengthening the peroneal muscles is crucial for adolescent patients because of the footwear they typically select. Such footwear frequently limits natural body movements, which can lead to muscle weakness and imbalances within the lower leg. The restrictions imposed by these shoes can have long-term consequences on the ankle and foot, especially following an injury.