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Fig. 8.36 Lateral approach for ostectomy of the cuboid, (a) Incision on the lateral border of the left foot. The articular surface of the cuboid is visible in the wound, (b) A large plantar ulcer is seen below the incision.

Fig. 8.36 Lateral approach for ostectomy of the cuboid, (a) Incision on the lateral border of the left foot. The articular surface of the cuboid is visible in the wound, (b) A large plantar ulcer is seen below the incision.

elevation in his WBC count. His diabetes was very poorly controlled as evidenced by a markedly elevated HbAlc of 12.2%. Initial treatment consisted of a well-padded compression dressing and elevation of the limb. The patient was then immobilized in a non-weightbearing cast, which was changed every 3 weeks for 2.5 months. During a cast change, at 12 weeks postimmobilization, an ulcer was noted at the apex of his collapsed mid-foot (rockerbottom deformity). Radiographs revealed that the ulcer was located directly beneath the cuboid, which was plantarly displaced. The surgical treatment for this patient included percutaneous lengthening of the Achilles tendon, with ostectomy of the cuboid performed through a lateral approach. Intraoperative and postoperative photographs illustrate the surgical approach (Fig. 8.36a,b). His postoperative course was uncomplicated and his plantar ulcer

Cuboid Ulcer Images
Fig. 8.37 The same patient as in Fig. 8.36(a,b). (a) The foot is well healed, (b) Patella tendon bearing brace with custom-moulded shoes and rocker soles.

healed well. He wears custom-moulded shoes and a patella-tendon bearing brace. Although there is some residual deformity, the patient remains lesion free (Fig. 8.37a,b).

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