04/04/2016    Timothy P. Shea, DPM

Gait Abnormality

When evaluating patients who have gait
disturbances, especially after accidents,
injuries or surgeries. If the general examination
is negative for gross discrepancies such as
neurological or musculo-skeletal defects look to
the rear foot and ankle function for subtle
changes that change gait function.

The term commonly used is "cuboid syndrome " or
"cuboid dysfunction". Although the idea has been
around for many years this topic is still
considered controversial. It was initially
postulated by Dr. John Hiss MD and Dr. John
Mennell MD back in the 1940-50s. Its premise is
that the rear foot/ankle is "jammed" in a car
accident (the foot shoved into the floor board),
and as a result the lateral column of the foot (
calcaneus-cuboid joint and mid-foot joints)
become dysfunctional and throw out the
biomechanics of the mid- and rearfoot.

This then leads to closed kinetic chain
abnormalities of the muscles (such as the
peroneal and posterior tibial) and ligaments such
as the plantar fascia to become weak and
overused. The net result is gait abnormalities
which only become symptomatic after a period of
time in people who are active.

In almost 45 years of practice, I have seen this
phenomenon play out many times involving car
accidents 6-12 months later. Again nerve testing
and standard x-ray/MRI/CT etc. are negative. The
treatments of choice is a combination of
aggressive foot reconditioning, such as joint
manipulation and therapy, taping-strapping, home
exercises, braces and foot inserts, shoe
modification, until the patient can return to
the activity they were doing before the injury.
If you are able to provide this type of treatment
then do so.

Alternatively, local therapists involved in
sports medicine,chiropractors, non-surgical
orthopedists and podiatrists who understand
"manipulative therapy" of the foot could help

Timothy P. Shea, DPM, Concord, CA

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