Cuboid stress fracture as an uncommon cause of lateral foot pain: Correlation between magnetic resonance imaging and photon-counting computed tomography - A case report

Cuboid stress fractures are uncommon causes of lateral midfoot pain and may be overlooked when initial radiographs are normal. We report a 30-year-old recreational athlete who developed progressive laeral midfoot pain after an increase in running volume and interval training. Conventional radiographs showed no fracture. Magnetic resonance imaging demonstrated extensive bone marrow edema in the cuboid and a mediolaterally oriented fracture line extending to the articular surface of the fifth tarsometatarsal joint, with a small focal depression of the involved articular surface. Photon-counting computed tomography performed one month later demonstrated a thin sclerotic fracture line with a small central lucency corresponding to the magnetic resonance imaging abnormality and provided detailed characterization of the osseous fracture morphology. The patient was treated conservatively with activity restriction, protected weight-bearing, and foot orthoses. Follow-up magnetic resonance imaging demonstrated decreased bone marrow edema and reduced conspicuity of the fracture line, consistent with interval healing. The patient subsequently completed a gradual return-to-running program without recurrent lateral midfoot pain. This case underlines cuboid stress fracture as an important differential diagnosis in persistent lateral foot pain despite normal radiographs and illustrates the complementary morphological information provided by photon-counting computed tomography regarding fracture morphology and articular involvement.