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

Cuboid fracture

by Nicole
(Sacramento )

I fell down the stairs and twisted my left foot, I felt a crack and went to the clinic. They said the suspected a cuboid injury where the tendon takes a piece of bone. They put me in a boot and to follow up with dr. I went to my dr and he said stay in boot for 2 weeks. The clinic called after that and said the X-ray didn't show anything and don't have to wear boot. I had bad bruising at the end of my toes and along the bottom of my foot. I took the boot off and now I'm having bad pain on the side of my foot like in the arch area when I walk and there is a buldge on the top left side

RESPONSE

Hi Nicole,

Based on your narrative it sounds more like the base of the fifth metatarsal bone may be affected rather than the cuboid as the base of the fifth metatarsal has a tendon inserting into it, while the cuboid does not. It is academic in the sense that the pain is the result of trauma and initial x-rays show no sign of fracture.
However, sometimes small "cracks" in bone will not show up initially on x-ray and only ten days later will they show up due to x-ray changes seen in healing bone.
In any event, you do not have to have a broken bone in order to wear a boot. If you do not actually have a broken bone, then at the very least you either have a strained ligament or a strained tendon. In these instances wearing a boot to immobilize the foot and

reduce strain on the ligament and tendons will go a long way to make the foot less painful and to aid in the healing process.
Of course I have no idea what is going on with your foot as I do not have the luxury of examining you but at the very least, if the foot hurts get back into the boot.
If the foot continues to hurt in the boot as well then the foot will have to be re-evaluated. A new x-ray may have to be taken, or possibly an MRI to rule out soft tissue damage.
I would hope the doctor who you went to see is either a podiatrist or an orthopedist as they are the only two specialties that are familiar with sprains of the foot and the resulting trauma. A family doctor is not your best bet because an improper diagnosis will only delay healing.
Now, if once again your foot feels better in the boot, even without a fracture, you may have to wear the boot for a few weeks until there is a reduction in pain to the point where you can walk without the boot.
Again, assuming you wear the boot and there is no pain, but the lump on the top of your foot persists, then you would want to bring that to the attention of your doctor as well.
The lump could be nothing more than inflammation, but it could also be the result of a broken bone or ruptured tendon. Do not ignore it if it persists.

Marc Mitnick DPM
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ADDITIONAL REFERENCES

Mayo Clinic

Johns Hopkins Medicine

MedlinePlus

Arthritis Foundation

University of Rochester Medical Center

Harvard Health

Drugs.com

American Academy of Pediatrics

Penn State Medical Center

National Institutes of Health

Columbia University Department of Rehabilitation

ScienceDirect

Stanford Health Care

Illinois Bone and Joint Institute

Mount Sinai Hospital

Institute for Chronic Pain

University of Florida Health

American Family Physician

Cedars-Sinai

University of Maryland Medical Center

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Wonderful advice

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location unknown

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location unknown

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