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SUPINATED FOOT AND ANKLE, aka TYPE II CUBOID SYNDROME

3/16/2012

11 Comments

 
(18/2/06 3:59 am)
Jerry's Reply

Cuboid
    
Good answers re the topic of cuboid syndrome. I have treated this for 2 decades, so I have some thoughts. I intended to submit a letter to the editor after the article cited earlier in JOSPT in 2005, but never did. In my opinion, there are essentially 2 basic types of cuboid syndrome. I do not believe that this has been adequately addressed in the literature. For convenience I am going to name one type a TYPE I CUBOID SYNDROME  and the other a TYPE II CUBOID SYNDROME. 

Type I can be symptomatic or asymptomatic.  It responds beautifully to a manipulation of the cuboid, and the cuboid alone.  If painful, the pain resolves very quickly and the treatment is repeated if necessary, 1 or 2 times. Client and clinician are both happy. Recovery is quick.
Basically the cuboid fixation is the key lesion in the foot and ankle complex and restoring mobility directly to the cuboid makes for significant improvement.  Sometimes there is a pattern that appears to involve several other structures in the foot and ankle, yet the manipulation performed only at the cuboid, is almost magical. Retesting the other motion fixations reveals that they are also remarkably improved and they do not require treatment. I affectionately and metaphoriclly refer to the cuboid as "1/2 of a keystone." It has no lateral
structure to articulate with, as it is the most lateral of that row of mid foot bones. When it subluxes laterally with foot and ankle in inversion, there is much to hold it out there, the articulating lateral cunieform and the articulating calcaneus. The navicular also articulates with the cuboid, and the 4th and 5th metatarsals proably play a rather minor role. It is very helpful to have a foot and ankle model that includes the whole foot and a short portion of
the distal tibia and fibula, of course talus and calcaneus included. Take apart the joint leaving the forefoot, the cuneoforms, the navicular and the cuboid as one and the talus and calcaneus are seperate (as is their attachment to the distal tibia and fibula. It is so helpful to learning, to have this semi-disarticulated model in hand. You can put the pieces together and observe how the bones interact. It should be easy to perceive how the cuboid is "out there by itself" being most lateral and it is easy to see how it could be elevated (vertical axis) and laterally rotated about an A-P axis,  remaining stuck in an inversion injury. 

The cuboid can be palpated and compared to the unaffected side. Typically it is more prominent on the painful side and inferior glide spring testing and "pronatory" spring testing reveal fixation (and discomfort). I do not believe that one can NOT accurately perform a
superior glide spring test due to thickness of the soft tissue on the plantar surface of the foot. The typical manipulation is opposite to the way I prefer to mobilize it. The typical manipulation involves a superior thrust from the plantar surface of the foot, see details in other post, below. The typical manipulation appears to enhance the lesion - yet gap the joint and I believe that it recoils back to normal position. I prefer to mobilize it with progressive inferior glide (dorsal to plantar direction)and add medial rotation mobilization, while I attempt to "create space" and coax it back by taking the navicular and the cuboids into medial glide and medial rotation.  

Now a description of what I conveniently refer to as TYPE II CUBOID SYNDROME. This can be symptomatic or asymptomatic, with all grades in between from acute to chronic. The difference is that a supinatory pattern of the foot and ankle complex has set in and efforts to mobilize only the cuboid will fail miserably, will not provide that quick fix, described earlier.
Instead, you have to treat all major articulations and this is where we get into some controversy. This same pattern is commonly encountered in recurrent ankle sprains. I find restrictions (in the oppsite directions) and restore mobility in the following directions:

MAJOR MOTIONS OF THE FOOT AND ANKLE: 
  • posterior glide of the talus - the method also mobilizes the calcaneus anteriorly at the same time 
  • medial rotation of the talus 
  • +/- internal rotation of the talus 
  • +/- posterior glide of distal tibia 
  • +/- medial rotation of distal tibia 
  • posterior glide of the distal malleolus (on rare occasions it is found to be stuck posteriorly thus mobilized nteriorly) 
  • +/- ant or post glide of fibular head 
  • superior glide of the fibula (not described in the bulk of the literature, but indeed a very relevant, seperate accessory motion - great research project) This does NOT self-correct as a coupled motion with mobilization/Muscle Energy in A-P, or P-A directions. 
  • inferior glide and medial rotation of the navicular and then incorporating the cunieoforms 
  • inferior glide and medial rotation/medial glide to the cuboid superior/inferior glide to base of 5th metatarsal  
  •  last but not least is the calcaneus:
At this point one will typically note that the calcaneus still has restricted eversion and abduction and the secret to restoring valgus/eversion (ultimately to restore normal functional pronation) is actually to mobilize the above bulleted sequence and then the calcaneus 30x into abduction and the valgus/eversion is then restored automatically without directly performing a valgus/eversion force. The abduction is the key - of course, after the above sequence. I think that I might be one of the first to name the abduction as a necessary motion in restoring calcaneal valgus (late 1980's) - I just stumbled on it many years ago in the clinic - but if you have a reference that says otherwise, please let me know. 

Sometimes just before the final mob to the calcaneus I will evaluate and treat if needed, medial glide to the talus working through the distal fibula and just below it as well. After all of the above I go into a weight-bearing context and adress those motions that I can - if I find them to be restricted in weight bearing, such as distal tibia rotation, calcaneal valgus, etc. I teach the client to internally rotate from hip down to distal tibia and gently, repeatedly self-mobilize into pronation 30-100 reps, daily for a week and then as needed. 

There are other flavors in which there is enough laxity in the ligaments that the above is not
effective, fortunatley these are in the minority and I am not referrring to this sub-population is this commentary. There is a great need for more research on the above topic and I think that our profession does not typically look at structures as patterns of motion dysfunction. The Cuboid Syndrome a perfect example in which only one dysfunctional structure (the cuboid) is mentioned and only mobilization to that singular structure is described. I have made a case
for Type II Cuboid Syndrome being a much more complex pattern that requires a dozen or more sequential mobility screens and treatment with mobilization. Terms like hypermobility and hypomobility get tossed around in the literature without adequate clarification, without explaining in detail, the tests are used with the cuboid.
11 Comments
Sheila Smith
12/3/2018 03:32:38 pm

Dear Jerry. Your a Practical Genius and very a very skilled Master! I have just started watching your YouTube videos on Cuboid Syndromes and for the first time in 20 years, YOU are telling me what I have tried to find help for! NO ONE, has been able to help me with this except for my dear friend Rev. Bob Villars, who was a very gifted LMT, body worker who sadly passed on several years ago. I used to be an LMT, and also dropped out of Med School. So, I have a better than average understanding of anatomy and physiology! It is unfortunate for me, that I live in MN! Other wise, I would be at your office, post haste! I am wondering, if you have trained students in MN? I would love to find someone with whom you have trained, to work on me! God Bless you, Jerry! I am thrilled to have found your channel and website, and look forward to learning more! I would also like to know if you offer any course work! Sincerely! Sheila Smith, in Minnetrista, MN.

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<a href="https://companymoversinjeddah.wordpress.com/2019/02/15/%d8%b4%d8%b1%d9%83%d8%a9-%d9%86%d9%82%d9%84-%d8%b9%d9%81%d8%b4-%d8%a8%d8%b1%d8%a7%d8%a8%d8%ba-15-%d8%b9%d8%a7%d9%85-%d8%ae%d8%a8%d8%b1%d8%a9/">شركة نقل عفش برابغ ,15 عام خبرة</a>
<a href="https://companymoversinjeddah.wordpress.com/2018/12/12/%d8%b4%d8%b1%d9%83%d8%a7%d8%aa-%d9%86%d9%82%d9%84-%d8%b9%d9%81%d8%b4-%d9%88%d8%a7%d8%ab%d8%a7%d8%ab-%d8%a8%d8%a7%d9%84%d8%a8%d8%a7%d8%ad%d9%87/">شركات نقل عفش واثاث بالباحه</a>
<a href="https://companymoversinjeddah.wordpress.com/2018/12/12/start-moving-company-to-khamis-mushit/">وسائل نقل العفش بخميس مشيط</a>

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شركة نقل اثاث بالرياض link
5/4/2021 05:41:55 pm

http://emc-mee.com/blog.html شركات نقل العفش
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http://emc-mee.com/ شركة الفا لنقل عفش واثاث
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http://emc-mee.com/price-transfer-furniture-in-khamis-mushit.html اسعار شركات نقل عفش بخميس مشيط
http://emc-mee.com/numbers-company-transfer-furniture-in-khamis-mushit.html ارقام شركات نقل عفش بخميس مشيط
http://emc-mee.com/new-company-transfer-furniture-in-khamis-mushit.html شركة نقل عفش بخميس مشيط جديدة
http://emc-mee.com/transfer-furniture-from-khamis-to-riyadh.html شركة نقل عف&#

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شركة نقل اثاث بمكة link
5/4/2021 05:45:02 pm



http://jumperads.com/ نقل الاثاث
http://jumperads.com/transfer-furniture-riyadh.html شركة نقل عفش بالرياض
http://jumperads.com/transfer-furniture-jeddah.html شركة نقل عفش بجدة
http://jumperads.com/transfer-furniture-dammam.html شركة نقل عفش بالدمام
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http://jumperads.com/transfer-furniture-taif.html شركة نقل عفش بالطائف
http://jumperads.com/transfer-furniture-mecca.html شركة نقل عفش بمكة
http://jumperads.com/transfer-furniture-yanbu.html شركة نقل عفش بينبع
http://jumperads.com/transfer-furniture-in-najran.html شركة نقل عفش بنجران
http://jumperads.com/transfer-furniture-in-khamis-mushait.html شركة نقل عفش بخميس مشيط
http://jumperads.com/transfer-furniture-abha.html شركة نقل عفش بابها
http://jumperads.com/transfer-furniture-buraydah.html شركة نقل عفش ببريدة
http://jumperads.com/transfer-furniture-qassim.html شركة نقل عفش بالقصيم
http://jumperads.com/transfer-furniture-tabuk.html شركة نقل عفش بتبوك
http://jumperads.com/transfer-furniture-hail.html شركة نقل عفش بحائل
http://jumperads.com/transfer-furniture-dammam-khobar.html شركة نقل عفش بالخبر
http://jumperads.com/transfer-furniture-ahsa.html شركة نقل عفش بالاحساء
http://jumperads.com/transfer-furniture-qatif.html شركة نقل عفش بالقطيف
http://jumperads.com/transfer-furniture-jubail.html شركة نقل عفش بالجبيل

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شركة سكاي لنقل العفش link
5/4/2021 05:45:41 pm


شركة سكاي لخدمات نقل العفش والاثاث بالمنطقة العربية السعودية نحن نوفر خدمات نقل اثاث بالرياض ونقل عفش بالمدينة المنورة ونقل عفش بمكة ونقل عفش بالطائف نحن نقدم افضل نقل اثاث بخميس مشيط ونقل عفش بجدة

http://treeads.net/ شركة سكاي نقل العفش
http://treeads.net/blog.html مدونة لنقل العفش
http://treeads.net/movers-mecca.html شركة نقل عفش بمكة
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http://treeads.net/movers-hail.html شركة نقل عفش بحائل
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http://treeads.net/movers-baaha.html شركة نقل عفش بالباحه
http://treeads.net/movers-asseer.html ž

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شركة نقل عفش بالمدينة المنورة link
5/4/2021 05:46:21 pm



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http://www.domyate.com/2019/09/05/10-company-transfer-furniture-khamis-mushait/ شركة نقل العفش بخميس مشيط
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http://www.domyate.com/2019/09/05/best-company-transfer-furniture-khamis-mushit/ افضل شركات نقل اثاث بخميس مشيط
http://www.domyate.com/2019/09/05/company-transfer-furniture-khamis-mushit/ شركات نقل اثاث بخميس مشيط
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http://www.domyate.com/2019/10/03/price-cleaning-tanks-in-jeddah/ اسعار شركات تنظيف خزانات بجدة
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http://www.domyate.com/2019/09/22/%d8%a3%d9%86%d8%ac%d8%ad-%d8%b4%d8%b1%d9%83%d8%a7%d8%aa-%d9%86%d9%82%d9%84-%d8%a7%d8%ab%d8%a7%d8%ab-%d8%a8%d8%ac%d8%af%d8%a9/ شركات نقل اثاث بجدة
http://www.domyate.com/2019/09/22/best-company-movers-jeddah/ افضل شركات نقل اثاث جدة
http://www.domyate.com/2019/09/22/company-transfer-furniture-yanbu/ شركات نقل العفش بينبع
http://www.domyate.com/2019/09/21/taif-transfer-furniture-company/ شركة نقل عفش في الطائف
http://www.domyate.com/2019/09/21/%d8%b4%d8%b1%d9%83%d8%a7%d8%aa-%d9%86%d9%82%d9%84-%d8%a7%d9%84%d8%b9%d9%81%d8%b4/ شركات نقل العفش
http://www.domyate.com/2019/09/21/%d8%b7%d8%b1%d9%82-%d9%86%d9%82%d9%84-%d8%a7%d9%84%d8%b9%d9%81%d8%b4/ طرق نقل العفش
http://www.domyate.com/2019/09/20/%d8%ae%d8%b7%d9%88%d8%a7%d8%aa-%d9%86%d9%82%d9%84-%d8%a7%d9%84%d8%b9%d9%81%d8%b4-%d9%88%d8%a7%d9%84%d8%a7%d8%ab%d8%a7%d8%ab/ خطوات نقل العفش والاثاث
http://www.domyate.com/2019/09/20/best-10-company-transfer-furniture/ افضل 10 شركات نقل عفش
http://www.domyate.com/2019/09/20/%d9%83%d9%8a%d9%81-%d9%8a%d8%aa%d9%85-%d8%a7%d8%ae%d8%aa%d9%8a%d8%a7%d8%b1-%d8%b4%d8%b1%d9%83%d8%a7%d8%aa-%d9%86%d9%82%d9%84-%d8%a7%d9%84%d8%b9%d9%81%d8%b4-%d9%88%d8%a7%d9%84%d8%a7%d8%ab%d8%a7%d8%ab/ اختيار شركات نقل العفش والاثاث
http://www.domyate.com/2019/09/20/cleaning-company-house-taif/ شركة تنظيف منازل بالطائف
http://www.domyate.com/2019/09/20/company-cleaning-home-in-taif/ شركة تنظيف شقق بالطائف
http://www.domyate.com/2019/09/20/ta

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شركة كيان لنقل العفش link
5/4/2021 05:47:12 pm



شركة كيان لنقل العفش بالرياض والمدينة المنورة وجدة ومكة والطائف والدمام تقديم لكم دليل كامل لشركات نقل العفش بالمملكة العربية السعودية
http://mycanadafitness.com/ شركة كيان لنقل العفش
http://mycanadafitness.com/forum.html منتدي نقل العفش
http://mycanadafitness.com/movingfurnitureriyadh.html شركة نقل اثاث بالرياض
http://mycanadafitness.com/movingfurniturejaddah.html شركة نقل اثاث بجدة
http://mycanadafitness.com/movingfurnituremecca.html شركة نقل اثاث بمكة
http://mycanadafitness.com/movingfurnituretaif.html شركة نقل اثاث بالطائف
http://mycanadafitness.com/movingfurnituremadina.html شركة نقل اثاث بالمدينة المنورة
http://mycanadafitness.com/movingfurnituredammam.html شركة نقل اثاث بالدمام
http://mycanadafitness.com/movingfurniturekhobar.html شركة نقل اثاث بالخبر
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http://mycanadafitness.com/movingfurniturejubail.html شركة نقل اثاث بالجبيل
http://mycanadafitness.com/movingfurnitureqatif.html شركة نقل اثاث بالقطيف
http://mycanadafitness.com/movingfurnitureahsa.html شركة نقل اثاث بالاحساء
http://mycanadafitness.com/movingfurniturekharj.html شركة نقل اثاث بالخرج
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http://mycanadafitness.com/movingfurnitureabha.html شركة نقل اثاث بابها
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http://mycanadafitness.com/movingfurnitureqassim.html شركة نقل عفش بالقصيم
http://mycanadafitness.com/movingfurnitureyanbu.html شركة نقل اثاث بينبع
http://mycanadafitness.com/movingfurnitureburaidah.html شركة نقل عفش ببريدة
http://mycanadafitness.com/movingfurniturehafralbatin.html شركة ن

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شركة ريلاكس لنقل العفش والاثاث link
5/4/2021 05:48:18 pm



http://fullservicelavoro.com/ شركة ريلاكس لنقل العفش والاثاث
http://fullservicelavoro.com/2019/01/07/transfer-movers-taif-furniture/ شركة نقل عفش بالطائف
http://fullservicelavoro.com/2019/01/08/transfer-movers-riyadh-furniture/ شركة نقل عفش بالرياض
http://fullservicelavoro.com/2019/01/08/transfer-movers-jeddah-furniture/ شركة نقل عفش بجدة
http://fullservicelavoro.com/2019/01/01/transfer-and-movers-furniture-mecca/ شركة نقل عفش بمكة
http://fullservicelavoro.com/2019/01/07/transfer-movers-madina-furniture/ شركة نقل عفش بالمدينة المنورة
http://fullservicelavoro.com/2019/01/07/transfer-movers-khamis-mushait-furniture/ شركة نقل عفش بخميس مشيط
http://fullservicelavoro.com/2019/01/09/transfer-movers-abha-furniture/ شركة نقل اثاث بابها
http://fullservicelavoro.com/2019/01/07/transfer-movers-najran-furniture/ شركة نقل عفش بنجران
http://fullservicelavoro.com/2019/01/16/transfer-movers-hail-furniture/ ِشركة نقل عفش بحائل
http://fullservicelavoro.com/2019/01/16/transfer-movers-qassim-furniture/ شركة نقل عفش بالقصيم
http://fullservicelavoro.com/2019/02/02/transfer-movers-furniture-in-bahaa/ شركة نقل عفش بالباحة
http://fullservicelavoro.com/2019/01/13/transfer-movers-yanbu-furniture/ شركة نقل عفش بينبع
http://fullservicelavoro.com/2019/01/18/%d8%af%d9%8a%d9%86%d8%a7-%d9%86%d9%82%d9%84-%d8%b9%d9%81%d8%b4-%d8%a8%d8%a7%d8%a8%d9%87%d8%a7/ دينا نقل عفش بابها
http://fullservicelavoro.com/2019/01/13/%D9%86%D9%82%D9%84-%D8%A7%D9%84%D8%A7%D8%AB%D8%A7%D8%AB-%D8%A8%D8%A7%D9%84%D9%85%D8%AF%D9%8A%D9%86%D8%A9-%D8%A7%D9%84%D9%85%D9%86%D9%88%D8%B1%D8%A9-%D8%A7%D9%87%D9%85-%D8%B4%D8%B1%D9%83%D8%A7%D8%AA/ نقل الاثاث بالمدينة المنورة
http://fullservicelavoro.com/2019/01/12/%D8%A7%D8%B1%D8%AE%D8%B5-%D8%B4%D8%B1%D9%83%D8%A9-%D9%86%D9%82%D9%84-%D8%B9%D9%81%D8%B4-%D8%A8%D9%85%D9%83%D8%A9/ ارخص شركة نقل عفش بمكة
http://fullservicelavoro.com/2019/01/07/transfer-movers-elkharj-furniture/ شركة نقل عفش بالخرج
http://fullservicelavoro.com/2019/01/07/transfer-movers-baqaa-furniture/ شركة نقل عفش بالبقعاء
http://fullservicelavoro.com/2019/02/05/transfer-furniture-in-jazan/ شركة نقل عفش بجازان

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ارخص شركة نقل عفش وأثاث بمكة link
5/4/2021 05:48:54 pm



https://sites.google.com/view/movers-riyadh/
https://sites.google.com/view/movers-riyadh/movers-mecca
https://sites.google.com/view/movers-riyadh/home
https://sites.google.com/view/movers-riyadh/movers-jedaah-elhamdniah
https://sites.google.com/view/movers-riyadh/movers-yanbu
https://sites.google.com/view/movers-riyadh/movers-najran
https://sites.google.com/view/movers-riyadh/movers-Jizan
https://sites.google.com/view/movers-riyadh/jazan
https://sites.google.com/view/movers-riyadh/taif
https://sites.google.com/view/movers-riyadh/moversjeddah
https://sites.google.com/view/movers-riyadh/movers-abha
https://sites.google.com/view/movers-riyadh/movers-elahsa
https://sites.google.com/view/movers-riyadh/movers-elkhobar
https://sites.google.com/view/movers-riyadh/movers-elkharj
https://sites.google.com/view/movers-riyadh/movers-elmadina-elmnowara
https://sites.google.com/view/movers-riyadh/movers-eljubail
https://sites.google.com/view/movers-riyadh/movers-elqassim
https://sites.google.com/view/movers-riyadh/movers-hafrelbatin
https://sites.google.com/view/movers-riyadh/movers-elbaha
https://sites.google.com/view/movers-riyadh/movers-jeddah
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    Jerry Hesch, MHS, PT, DPT(s) – Las Vegas Physical Therapy

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    Dr. Jerry Hesch, DPT, MHS, PT

    Married with 4 grown kids.  Earned my Doctorate at A.T. Still University in Tempe, AZ, MHS at the University of Indianapolis and my BS PT at University of New Mexico.  I enjoy working with my hands and particularly making glass objet d'art.

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