Cuboid Fracture - trainer/biking ok?

Triathlon Forum
1

I rolled my right foot about 10 days ago (a week ago this past Saturday). I had pain when walking, especially when pushing off. The day after it happened, I rode for about 3 hours with no pain and swam without pushing-off, using the right leg (thinking it was just a dislocated cuboid - based on my Internet diagnosis). To be safe I went to the Dr the Monday after it happened, he took x-rays and diagnosed a fractured Cuboid. He put me in a walking/air cast, and said I would be in it for 6 weeks, with a check-up after 3 weeks. Looking at the X-ray, he pointed to what he believed to be fractures on the x-ray (“see that line, it should not be there”), but admittedly, I couldn’t see it. In any event, he suggested that I could still swim, bike and aqua-jog, but of course no running for at least 6 weeks (that would put me at April 5th).

After all my reading of the Internet, etc., I am not certain where biking plays into this. I have no pain when biking or swimming, but it seems there is a large consensus to keep the foot immobilized for an extended period (e.g., 3 weeks). I am going in for a 2nd opinion with a foot specialist on Thursday morning, but just wanted to hear from others as to what has been recommended.

All this being said, I am also trying to get a realistic feel for my race schedule.
April 26 - Texas 70.3
June 28 - IM Coeur d’Alene
Nov 15 - IM Arizona

Going into this year, I wanted to go hard at Texas HIM and IMAZ, using IMCDA as a training race. Thinking I would be able to bike during recovery, my revised plan included staying in shape on the bike and in the pool, getting a couple of weeks of running in before Galveston to just have a good bike/swim with a slow paced easy run (and enjoy what has always been a fun weekend with my wife and friends that race too). Then, roll that into an ok amount of running in before IMCDA to enjoy a laid back race and vacation. Finally, roll that into good training for IMAZ. Now, I am not so sure - should I just abandon Texas and IMCDA? The reason I asks is we are in the process of booking flights and accommodations for IMCDA, and I wonder if I should just cut my losses.

2

Get a good diagnosis first since it can be hard to differentiate cuboid syndrome from a cuboid stress fracture. This is especially important with your race plans as you have to know with training, flights, hotels, etc.

Plain film X-rays usually won’t show a cuboid stress fracture, and an acute cuboid fracture fracture usually requires prolonged, non weightbearing immoblization, or more frequently today in athletes, screw fixation since they are often very slow healing injuries. Unless very obvious on X-ray, ask for a CT or MRI to confirm. These rarely heal in 6 weeks.

3

Thanks.

Anyone have a recommendation for a sports / foot specialist in the Austin area?

4

I’m going in for an X-ray tomorrow at my Ortho’s office. I rolled my foot at the bike start of IMW one week ago. (Finished the bike and ran the marathon, couldn’t push off to the left whatsoever, still can’t) Ibuprofen does mitigate the pain when walking.

Have you fully recovered?

How did your recovery progress?

I have a really, really long bike race in two weeks.

If it’s fractured will I be okay riding on it?

Any helpful advice will be appreciated. Thanks.

5

Get a good diagnosis first since it can be hard to differentiate cuboid syndrome from a cuboid stress fracture. This is especially important with your race plans as you have to know with training, flights, hotels, etc.

Plain film X-rays usually won’t show a cuboid stress fracture, and an acute cuboid fracture fracture usually requires prolonged, non weightbearing immoblization, or more frequently today in athletes, screw fixation since they are often very slow healing injuries. Unless very obvious on X-ray, ask for a CT or MRI to confirm. These rarely heal in 6 weeks.
When I fractured my cuboid about a decade ago the foot specialist couldn’t pick it up in the x-ray initially, only after an MRI could he tell where it was. For me it was no riding for 6 weeks, then light riding was OK but no hard efforts until after week 12.

6

One doc was able to locate the fracture on an X-ray but the other was not, and it took an MRI too see it. A short summary of the series of events is here:
http://forum.slowtwitch.com/gforum.cgi?post=4879646;search_string=;#4879646

In short, I biked pretty much through the process (trainer, minimal outside with NO STANDING), only taking a week off from biking late in the process to help it along when I felt like it was close but not healing completely (basically being cautious). I swam a lot. In the end, I was out of the boot at exactly 4 months. As far as long bike rides, I did a few 70-80 miles rides, but I felt like each may have been a small setback each time. I don’t think it is the length of the ride, but the tendency to stand or push hard without thinking about it. I did several 3-4 hour trainer rides and never felt a thing afterwards. Coming back, I slowly transitioned into running, starting with a 1.5 miles and adding about .5 mi every other day. When the foot felt weird, I would skip running for a couple of days and then pickup where I left off. Interestingly, I think swimming caused the most problems over the first 6 weeks after the 4 mo - due to me inadvertently pushing off of the wall when I felt better, and a couple of times trying to work in some flippers.

All this being said, I did a an IM about 6.5 weeks after coming out of the boot and felt fine.

7

Thank you for the link and info. I hope it’s not broken. Either way I bet he has me in a boot before noon. I’ll report back.

Thank you.

8

The xray showed nothing. He poked on the spot that hurts. He said he could have an MRI done but that probably wouldn’t change his plan. No boot since I’m walking fine and pain free in normal training shoes. Rest it. Don’t do anything that makes it hurt. Stay off it as much as possible, ice/heat whatever makes it feel good. It’s only been a week so lets see if rest does the trick. That’s about it. I’ll ride easy tomorrow and see how that goes.

9

That is good news. Personally, I would still be a bit cautious and easy on the foot until you are able to push-off and pain free (it was not clear from your post whether the push-off problem was only during the IM, or if it is still around). My cautionary words are that I never felt any real pain - it was just a “not right” feeling. You may want to limit (or at least be aware during) the impact type stuff like speed work, pushing hard on the bike, pushing off of the wall in swimming or the flippers until you are confident. Those are the things I noticed - never really painful, but just had a lingering “not right” feeling the day after.

10

Thank you. The pushing off is while walking around so I will go easy for a while. Hopefully it will settle down. Thanks for your help.

Josh

11

I went into full caution mode for two weeks after the X-ray. I limped even when the foot felt okay, lifted a little, only rode a couple times before my long bike event 7 days ago.

Three weeks post injury foot felt fine to ride. I went 167 miles out of a planned 323 with no foot pain. Pulled out do to lack of training not foot issues.

Began regular training, swimming caused the most discomfort, although it was on the top of the foot near the ankle when kicking, like it was tight not limber enough. Pushing off the wall was no problem. Swam, biked and lifted normally all week.

Did short 30 minute run Thursday. All good.

Must not have been cuboid fracture. Maybe deep bone bruise?

Rest did the job. Now back to training.

12

cldtx, how long until you were able to start running again?

I was trail running with my husband and our two dogs 6 days ago and got my foot stuck between some logs and torqued it.

I was intially able to weight bear and walked home gingerly. Very little swelling, iced it. As the night progressed, I wasn’t able to weight bear.

We went for x-rays and they said ligament damage and a possible bone chip on the medial side (where I basically had very little pain). Sent me to the fracture clinic as they weren’t sure, the next day at the clinic they looked at the x-rays and said they thought I had a cuboid fracture, but would have to do a CT scan to be sure. As the treatment didn’t change, I said not to bother.

Air cast, crutches, work at home.

I started being able to carefully walk in the cast without crutches. Then I could gingerly walk without the air cast around our apartment. It still hurts to move my toes but not as much. Basically intra-foot movement is still painful, but that could be from the ligaments? I dunno. The whole area is still tender.

I have been using a TENS unit on the area to try to increase blood flow and promote healing. I go back to the fracture clinic and see ortho in just over 2 weeks.

Today I walked 200m in the air cast without crutches. A bit ouchie. Tells me I’m not ready for the subway and going to work (for whatever reason, I’m struggling with crutches this time and keep falling on stairs).

Just wondering when you got back to running. Was thinking of trying to give biking a go in the next couple of days, though I think putting on shoes would be very painful. Putting the air cast on hurts if I ‘slide’ my foot in.

Does this sound similar to what you experienced? I would like to do some snowshoe races in the winter, as well as some backpacking and pulk-pulling trips over the winter and am really hoping for good news. I’ve read stuff that says cuboid fractures can take 12 months to heal which has me freaking out!

13

It was about 4 months. Below is a quote from my timeline above (I refer to this because I can’t remember all of the details now). Given you are experiencing pain, I would err on the side of caution. I never had much pain – it was somewhat painful at time, but mostly just felt like something was wrong/fragile. I eventually got a bone growth simulator after it did not heal – I am not sure if it worked, but at least I felt like it was doing something. I had a false start when the doc gave me a go ahead to run (~week 6), and I am not sure if that set me back???

In short, I biked pretty much through the process (trainer, minimal outside with NO STANDING), only taking a week off from biking late in the process to help it along when I felt like it was close but not healing completely (basically being cautious). I swam a lot. In the end, I was out of the boot at exactly 4 months. As far as long bike rides, I did a few 70-80 miles rides, but I felt like each may have been a small setback each time. I don’t think it is the length of the ride, but the tendency to stand or push hard without thinking about it. I did several 3-4 hour trainer rides and never felt a thing afterwards. Coming back, I slowly transitioned into running, starting with a 1.5 miles and adding about .5 mi every other day. When the foot felt weird, I would skip running for a couple of days and then pickup where I left off. Interestingly, I think swimming caused the most problems over the first 6 weeks after the 4 mo - due to me inadvertently pushing off of the wall when I felt better, and a couple of times trying to work in some flippers.

All this being said, I did a an IM about 6.5 weeks after coming out of the boot and felt fine.

14

It was about 4 months. Below is a quote from my timeline above (I refer to this because I can’t remember all of the details now). Given you are experiencing pain, I would err on the side of caution. I never had much pain – it was somewhat painful at time, but mostly just felt like something was wrong/fragile. I eventually got a bone growth simulator after it did not heal – I am not sure if it worked, but at least I felt like it was doing something. I had a false start when the doc gave me a go ahead to run (~week 6), and I am not sure if that set me back???

In short, I biked pretty much through the process (trainer, minimal outside with NO STANDING), only taking a week off from biking late in the process to help it along when I felt like it was close but not healing completely (basically being cautious). I swam a lot. In the end, I was out of the boot at exactly 4 months. As far as long bike rides, I did a few 70-80 miles rides, but I felt like each may have been a small setback each time. I don’t think it is the length of the ride, but the tendency to stand or push hard without thinking about it. I did several 3-4 hour trainer rides and never felt a thing afterwards. Coming back, I slowly transitioned into running, starting with a 1.5 miles and adding about .5 mi every other day. When the foot felt weird, I would skip running for a couple of days and then pickup where I left off. Interestingly, I think swimming caused the most problems over the first 6 weeks after the 4 mo - due to me inadvertently pushing off of the wall when I felt better, and a couple of times trying to work in some flippers.

All this being said, I did a an IM about 6.5 weeks after coming out of the boot and felt fine.

Thank you! This is helpful! Thinking on it, I may have fractured at the calcaneous/cuboid joint (I’m a bit confused and need to follow up) but this is still great. I will give it a bit more than try riding on the trainer. I’ll be very cautious with running, see what ortho says and when I can walk 5k pain free I will try a short run. I think that’s probably reasonable.