How do you manage a chronic rocker bottom deformity with a prominent cuboid bone?
Rocker bottom deformities are a major concern because they typically occur in the diabetic patient with significant peripheral neuropathy and Charcot changes. As a result, the apex of the rocker bottom deformity is the site of greatest peak plantar pressures. Combined with the sensory neuropathy, there is an increased risk of skin breakdown with subsequent ulceration to this area. In the absence of ulceration, conservative management should be instituted initially, with prescription custom-molded shoes and inserts dispensed to decrease the peak plantar forces with ambulation. The patient also should be instructed to examine this area daily to evaluate for any signs of skin injury. Should conservative measures fail to prevent ulceration, surgical intervention is warranted. Surgery may consist of a simple exostectomy, to decrease the osseous prominence and hence the peak plantar pressures. However, exostectomy of the cuboid may be insufficient, given that the lateral column of the foot b
