Calcaneocuboid Injection

Other Names

• Calcaneocuboid Injection

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Background

The calcaneocuboid joint

Key Points

• Transducer: high freuqency, linear
• Needle: 25-gauge, 1.5-inch needle

Anatomy of the Calcaneocuboid Joint

• Transverse Tarsal Joint: formed by the calcaneocuboid joint and talonavicular joint
  • Sometimes called the 'Chopart Joint'
• Calcaneocuboid Joint
  • Formed by the calcaneus and cuboid bones
  • Stabilizing ligaments: bifurcate ligament, dorsal calcaneocuboid ligament, long plantar ligament, and plantar calcaneocuboid ligament
  • Considered one of the least mobile joints of the foot
  • Can rotate about 25 degrees about an oblique axis during inversion/eversion

Palpation Guidance vs Ultrasound Guidance

• There is no literature evaluating the accuracy of palpation guided injections
• Ultrasound guided injections have not been studied or published in the literature
• Both Fluoroscopic guided and CT guided injections have been described

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Indications

• Cuboid Syndrome

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Contraindications

• Absolute
  • Anaphylaxis to injectates
  • Overlying cellulitis, skin lesion or systemic infection
• Relative
  • Can be treated with less invasive means
  • Hyperglycemia or poorly controlled diabetes
  • Lack of symptom improvement with previous injection

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Procedure

Calcaneocuboid transducer placement on the lateral foot

Calcaneocuboid joint (longitudinal out of plane approach using step-down technique (dots)).

Lateral fluoroscopic image after injection of iodinated contrast shows needle placement along the mid portion of the joint to avoid the peroneal tendons with contrast outlining the cranial aspect of the calcaneocuboid joint (arrowheads). Peroneus brevis (white dotted line), peroneus longus transiting through cuboid tunnel (solid white line), calcaneus (Ca), cuboid (Cu), base of fifth metatarsal (M5)

Equipment

• Sterile prep (i.e. chloraprep, chlorhexidine, iodine, etc)
• Gloves
• Needle: typically 21-25 gauge, 1.5 inch
• Syringe: 5-10 mL
• Gauze
• Ethyl Chloride
• Bandage
• Injectate
  • Local anesthetic
  • Corticosteroid
• Sterile probe cover

Ultrasound Findings

• Best visualized in long axis, depth less than 3 cm
• Potential findings:
  • Cuboid subluxation
  • Cortical irregularities
  • Calcifications
  • Joint effusions
• Pathology of the Peroneus Longus tendon may also be appreciated

Ultrasound Guided Technique: Long Axis, Out of Plane

• Patient Position
  • The patient is supine
  • Foot flat on table with knee flexed
• Transducer Position
  • Long axis to the foot
• Needle Approach/ Orientation
  • Out of plane
  • Lateral to medial using a step-wise approach
• Target
  • Calcaneocuboid joint
• Pearls and Pitfalls
  • Identify the peroneus longus tendon, which passes adjacent to the joint

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Aftercare

• Motor exam should be intact
• No major restrictions in most cases
• Can augment with ice, NSAIDS
• Consider Ankle Compression Sleeve

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Complications

• Infection
• Damage to surrounding tissue

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See Also

• Procedures Main
• Ultrasound Main
• Ankle Pain Main

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