Anatomical Study of the Cuboid and Its Ligamentous Attachments and Its Implications for a Cuboid Osteotomy

Abstract

Background: Lateral column lengthening (LCL) for flexible flatfoot is an effective surgery with powerful correction of deformity because it tightens only the lateral third of the long plantar ligament (LPL). However, LCL has been associated with joint damage at the osteotomy site and loss of foot flexibility owing to joint fixation. We focused on the cuboid and investigate a novel anatomical LCL osteotomy site that effectively tightens the LPL without damaging any joints. Methods: We studied 24 feet of 12 cadavers (mean age, 80.8 years). The lengths of the LPL and short plantar ligament, locations of the attachments, and shape and location of the cuneocuboid joint on the medial side of the cuboid were studied. ImageJ software was used to measure the osteotomy angle. Results: The lateral cuboid attachment of the LPL on average was located 4.6 mm from the calcaneocuboid joint, and the cuneocuboid joint on average was located 6.7 mm from the cuboid-metatarsal joint on the medial surface of the cuboid. The direct line connecting the anterior cuneocuboid joint and the oblique crest of the cuboid on average was at a 10.3-degree inclination posterior to the cuboid-metatarsal joint. Conclusion: A straight line must be selected between a point 4 mm from the calcaneocuboid joint laterally and 6 mm from the cuboid-metatarsal joint medially at a 10-degree posterior tilt to the cuboid-metatarsal joint to perform a cuboid osteotomy LCL without damaging the articular surface. Clinical Relevance: We investigated a potential novel cuboid osteotomy method for LCL.

Anthropometric Analysis of Cuboid Bones in a South Indian Population

“…Tazaki et al suggested that cuboid osteotomy would be useful in lengthening the lateral column for flat foot correction. The osteotomy line on the cuboid should pass 4 mm from the calcaneocuboid joint laterally due to the attachment of the long plantar ligament, and on the medial side, 6 mm from the cuboid-metatarsal joint due to the presence of a navicular facet proximal to the cuneocuboid joint [7]. The presence or absence of a navicular facet depends on the type of gait pattern, weight transmission, and environmental and genetic factors.…”

“…The morphology and morphometric analysis of cuboid bone is crucial for designing the prosthesis for foot and ankle reconstructions and in finite element modeling (FE) or statistical shape modeling (SSM) [5,6]. Knowledge about cuboid morphometry can assist surgeons in understanding the basics behind lateral foot syndrome, which includes chronic pain, trauma, fracture dislocation, and joint instability associated with cuboid bone, and in cuboid osteotomy for lateral column lengthening in flatfoot deformity [7]. It also provides knowledge about the evolution of human bipedalism and the kinematics of the cuboid bone with adjacent tarsal and metatarsal bones, which can help during prosthesis design.…”