MRI of the cuboid bone: analysis of changes in diabetic versus non-diabetic patients and their clinical significance

Abstract

Objectives: (1) To investigate the association between diabetes and marrow changes in the cuboid; and (2) to evaluate the influence of age, gender, body mass index (BMI) and use of insulin in the occurrence of marrow changes in the cuboid.

Research design and methods: MR and X-ray foot examinations of 237 patients [94 males, 143 females; mean age, 47.1 years (range 16-93 years)], five of whom underwent bilateral examinations, were reviewed. MR and radiographic studies were analyzed for the presence of marrow edema and fractures in the cuboid. Findings were correlated with demographic data (age, gender) and clinical information (BMI and use of insulin).

Results: Two hundred and forty two feet - 69 diabetic and 173 non-diabetic - were retrospectively evaluated. There was a higher prevalence of marrow edema and fractures in the diabetic cuboid (n=31, 45%) compared to non-diabetic cuboid (n=25, 14%, p=0.02). A fracture line was seen in fourteen (20%) diabetic cuboid bones compared to 4 (2%) in non-diabetic cuboid bones (p<0.0001). Eleven (79%) cases of cuboid fractures in the diabetic population were radiographically occult. Multivariate data analysis revealed an adjusted odds ratio of 4.416 (95% CI; 2.307, 8.454) for the relationship between marrow changes (edema and fractures) in the cuboid and diabetes. For each year of age, the odds of changes in the cuboid increased by 2.2% (95% CI; 1.001, 1.044).

Conclusion: Despite not bearing weight, the cuboid bone is more vulnerable to marrow edema and fractures in diabetic patients compared to non-diabetic patients. Age seems to be an influential factor.