Differential diagnosis and treatment of iliotibial band pain secondary to a hypomobile cuboid in a 24-year-old female tri-athlete

Abstract

The purpose of this case report is to relate an episode of movement impairment at the cuboid calcaneal articulation leading to symptoms of iliotibial band (ITB) syndrome. An explanation of the etiology and clinical diagnosis in relation to the differential diagnosis, treatment techniques, and patient outcomes are described. The 24-year-old female tri-athlete reported pain at Gerdy's tubercle and lateral femoral condyle areas occurring within 2 miles of a run. VAS score was 6/10 for the running activity and the lower extremity functional scale (LEFS) score was 93% (74/80). Over the previous 2 years, the ITB symptoms had failed to resolve with extensive conservative treatment at the knee. On weight bearing, the patient demonstrated pain free limitation of active midtarsal pronation more than supination, which correlated with a decrease in passive internal rotation of the cuboid. Symptoms resolved after one cuboid whip manipulation and the patient was able to run pain free. Post-manipulation treatment consisted of two more sessions, which included motor retraining for weight bearing active midtarsal pronation and supination. LEFS was 100% (80/80) and VAS 0/10 with running greater than 10 miles. While causality cannot be inferred from a single case, this report may foster further investigation regarding the differential diagnosis and treatment of a hypomobile cuboid.

Short-Term Effects of Mobilization-with-Movement (MWM) and Auto-MWM Application in Recreational Runners with Iliotibial Band Syndrome

“…The reliability of the LEFS was found to be excellent (ICC= .94), [30,31]. It has been used in research according to ITBS with good results [32,33,9]. As it was mentioned before, all measurements were conducted by a blinded examiner.…”

Unique Practice Technique: Introducing the Tarsal Twist Manipulation

“…The preferred initial treatment for cuboid syndrome is manipulating cuboid bone [11,12]; otherwise, the available evidence on tarsal joint manipulations to treat foot dysfunction shows inconsistent evidence due to bias, research design flaws, and inadequate evidence sample size, and the evidence may not be generalizable [5]. However, cuboid manipulations have also been included in the successful management of other dysfunctions, including posterior tibialis tendinopathy [13] and iliotibial band pain [14], when cuboid mobility was found to be impaired.…”