Peroneus tendinopathy vs cuboid syndrome

[cathyt]

Hello

I am current seeing a patient who injured her ankle while snowboarding. She was unsure of the mechanism of injury.
After the accident she was able to continue to snowboard but now 5 days later the pain in her ankle has been steadily getting worse.

She has constant pain that's 6/10 now. The pain is felt at lateral food over the cuboid area.
The pain feels the worse when near toe off in gait cycle. However no restriction in movement was found and there was no decrease in strength upon testing.
So the differential diagnosis is either cuboid syndrome or Peroneus tendinopathy.

So I was just wondering, from clinical experience is there any specific tests or procedures that can be carried out to differentiate between the two?

Thank you very much for your advice.

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[cadynz]

hi cathy,
i realise your post is a little while ago but thought you may still appreciate some input...

might not be a case of one or the other - excessive traction on the peroneus can cause the cuboid to sublux.
have you had a feel of the foot? i've only had a couple of patients with this but in each one you could palpate that position of the cuboid and feel a difference left to right. often there is a depression on the dorsal aspect. or the lateral aspect of the cuboid may be more prominent.
the good news is if you diagnose it as a subluxed cuboid - the treatment can be a magic quick fix. you can manip it to reverse the subluxation and all of my patients felt an immediate improvement. you can then look at taping to maintain the position while you sort out the peroneus if that is the issue.
if you are not confident with a manip or your palpation i would try doing a dorsal glide of the cuboid and see if that changes her symptoms.
hope that helps, you may have cured her by now
cady