title: Two examples of 'cuboid syndrome' with active bone pathology: why did manual therapy help?
abstract: Cuboid syndrome describes lateral midfoot pain localised to the cuboid bone. Previously reported case studies promoted joint mobilisation or manipulation interventions. The assumed mechanism was correction of a subtle disruption to the calcaneocuboid joint position. There is an absence of evidence for correction of joint position, but there is evidence of neurophysiological mechanisms for pain modulation. This case study reports on a patient who suffered two occurrences of cuboid syndrome on opposite feet, three years apart. With both occurrences, joint mobilisation achieved rapid and lasting resolution of severe pain and functional limitations. This occurred despite the presence of an active bone pathology at the symptomatic cuboid (demonstrated with nuclear imaging), which could represent a stress reaction, transient osteoporosis, ischaemic necrosis, infection or neoplasm. This case contributes three considerations for clinical reasoning and manual therapy research. 1. Active local bone pathology could exist in other patients with pain at the cuboid, and other conditions where symptoms resolve with joint mobilisation. 2. Rapid and lasting symptom resolution fits with a hypothesis that joint mobilisation acted to reverse neurological sensitisation. 3. Lasting symptom resolution may be clinically associated with manual therapy, but mechanisms extending beyond temporary analgesia are yet to be identified.
authors.affiliation: The University of Queensland, School of Health & Rehabilitation Sciences, Centre of Clinical Research Excellence in Spinal Pain Injury and Health, Sports Injury Rehabilitation and Prevention for Health Research Unit, Australia.
authors.forename: Mark Lewis Gordon
authors.initials: ML
authors.lastname: Matthews
authors.affiliation: The University of Queensland, School of Health & Rehabilitation Sciences, Centre of Clinical Research Excellence in Spinal Pain Injury and Health, Sports Injury Rehabilitation and Prevention for Health Research Unit, Australia; Toowong Rehabilitation Centre, Queensland, Australia. Electronic address: a.claus1@uq.edu.au.
authors.forename: Andrew Philip
authors.initials: AP
authors.lastname: Claus
mesh_terms: D003937:Diagnosis, Differential; D005260:Female; D018409:Foot Injuries / Q000175:diagnosis / Q000534:rehabilitation*; D006801:Humans; D008875:Middle Aged; D026201:Musculoskeletal Manipulations; D010147:Pain Measurement; D013577:Syndrome
keywords: Cuboid; Manual therapy; Mobilisation; Neurophysiology