Cuboid syndrome is a condition that results from the trauma or injury to calcaneocuboid joint and surrounding ligaments. The cuboid bone is located on the outer side of the foot and is one of the seven tarsal bones of the foot. [01]
Cuboid syndrome is characterized by pain, tenderness, redness, and occasionally loss of mobility at the lateral side of the foot.
Cuboid syndrome is also known as cuboid subluxation. It is a common foot injury found in athlete & belle dancers.
Cuboid bone: Overview
Cuboid is one of the five bones that together make up the midfoot others are navicular and three cuneiform bones.
It is wedge-shaped and found in the outer side of midfoot. Posteriorly it connects with calcaneus bone while anteriorly it forms a joint with fourth & fifth metatarsals. [02]
Function of cuboid bone
Cuboid bone plays an important role in providing stability to the outer side of midfoot.
It forms the joint with other bones of the foot and helps to stabilize the foot. Along with other midfoot bones, it plays an important role in distributing the weight of the body across the foot and helps us to walk comfortably.
The bones and of the foot and joints within them helps in the flexion, extension, and ambulation of the foot. [03]
How Cuboid Syndrome Happens?
Severe trauma, ankle sprain or repetitive physical activities of the foot leads to the subluxation (partial dislocation) of this bone resulting in dull aching pain around the outer side of midfoot and difficulties in walking. This condition of the subluxation is also known as cuboid syndrome.
The condition is known by few other names like cuboid subluxation, cuboid fault syndrome, peroneal cuboid syndrome, blocked cuboid, lateral plantar neuritis and dropped cuboid. [04]
During walking or running, lower leg muscles go under certain movements causing contraction of muscles like peroneus longus. This contraction puts stress on small bones of midfoot & surrounding tissues, especially on cuboid bone.
When these forces are excessive and beyond the limit of what this small bone & its surrounding tissue can tolerate, a tear in these tissues may occur resulting in an abnormal alignment of cuboid bone causing a subluxation. [1.1]
What Causes Cuboid Syndrome?
Here are a few leading conditions that can cause the cuboid syndrome:
1. Sprained ankle
Ankle sprain can also be a cause of dropped cuboid. Especially an inversion sprain of the ankle, where ankle along with the foot excessively turns inward.
2. Repetitive Movements of lower leg muscles
Repetitive contractions of lower leg muscles can put extra stress on soft tissues that hold the cuboid bone in place & may lead to its tear resulting in subluxation of bone.
3. Severe foot injuries
Apart from a sprained ankle, other foot injuries involving the middle part of the foot may cause tear of connective tissues resulting in cuboid fault.
4. Dancing & Running
A repetitive dancing move (especially in belle dancing) that puts pressure on the foot can cause this problem.
Running barefoot may also lead to altered biometrics of foot and lead to dull aching pain middle part of the foot.
Risk factors
The most common risk factors for the cuboid syndrome are:
- Poorly fitting footwear.
- Being obese or overweight.
- Performing physical activities on an uneven surface.
- Practicing ballet dance is one of the most common causes of cuboid syndrome.
- Mid-foot bone fractures that surround the cuboid bone.
- Inadequate rest to the foot after physical activity.
- Conditions like osteoarthritis, gout, and osteoporosis increases the risk.
Cuboid Syndrome Symptoms
Cuboid syndrome is characterized by the following symptoms:
- Acute or chronic dull aching pain at the later side of the foot.
- Difficulties in walking
- Pain increase when a patient starts to walk of put pressure on the foot.
- Pain usually reduces after complete rest.
- Lateral part of the foot becomes tender to touch, red and swollen.
- Some patient may walk on their toes to avoid weight & pressure on cuboid bone.
Diagnosis of dropped cuboid
It is often possible to misdiagnosis the cuboid syndrome as even advanced imaging sometimes fails to provide a clue to subluxation of the cuboid bone.
After a thorough examination of the foot, the doctor may ask you to undergo advanced imaging to see if there is a cuboid fracture or just a subluxation. Advanced imaging is useful to rule out the other causes of foot pain.
Usually, a simple x-ray of the foot cannot able to capture the small fracture so the healthcare provider might advise MRI. Recent history of ankle sprain & co-relation of clinical findings with MRI report can confirm the diagnosis.
One can consider cuboid syndrome if the pain does not subside for more than three months following an inversion ankle sprain.
Cuboid Syndrome Treatment
Cuboid syndrome is primarily treated with conservative management that includes cuboid manipulation (squeeze or whip), padding, taping and using useful orthosis.
Home treatment of cuboid subluxation involves the RICE method which stands for the rest, ice application, compression and elevation of the affected foot.
Relocation
Relocation or manipulation of cuboid bone is the most important part of treatment. It involves the relocation of the dislocated cuboid bone to its anatomical position.
This procedure involves a fast thrust that pushes dislocated cuboid bone to its original position. This procedure must be carried out by the trained professionals only, like a podiatrist, orthopedic doctor, etc. & should never be tried at home.
Once the manipulation is over, other supportive treatment should be started.
Rest
No wonder rest is the first choice of supportive treatment for any foot ailment.
Rest prevents excessive stress on the foot bones and help the body to heal the injured connective tissues surrounding the cuboid bone.
If complete bed rest is not possible, one can use crutches or wheelchair to avoid the pressure of cuboid bone.
Ice pack application
Application of ice compressions to affected are can help to reduce congestion, swelling, and pain.
Place a thin towel over the foot and apply ice cold compressions to the mid part of the outer foot. Keep it for 5 to 6 minutes at a time then remove and repeat for three times a day.
Compression bandage
Compression bandage can be used to minimize movement of the foot.
After applying compression bandage, the elevation of the affected leg and rest is useful for a speedy recovery.
Cuboid Syndrome Taping & Padding
Taping is useful to stabilize the cuboid bone and allows soft tissues to recover by minimizing movement of ankle and foot.
Though there is insufficient evidence about the effect of taping in foot bio-mechanics and cuboid syndrome, few clinical studies show the positive outcome of taping when used with foot orthosis. [05]
Useful cuboid taping techniques –
- J-strapping technique
- Low dye taping
- Four mini stirrup method
Shop for one of the best kinesiology tape with water resistance feature on Amazon.
Wedge or padding can be used to support cuboid bone which will help to prevent recurrence of subluxation in the future.
Orthotics
Orthotics provide support to the foot and can be worn inside of the shoe.
It helpful for proper alignment of foot bones & reduces over-pronation of the foot.
Shop for the best cuboid support brace on Amazon.
Exercises
During the acute phase of an injury, exercises should not be practiced to avoid the aggravation of pain and inflammation of soft tissues.
Once the healing process starts and pain subsides, you should start exercise for strengthening
Cuboid Syndrome FAQs
Will cuboid syndrome heal on its own?
How painful is cuboid syndrome?
References:
[01] [1.1] Patterson S. M. (2006). Cuboid syndrome: a review of the literature. Journal of sports science & medicine, 5(4), 597–606. Available from: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3861761/
[02] Pountos, I., Panteli, M., & Giannoudis, P. V. (2018). Cuboid Injuries. Indian journal of orthopaedics, 52(3), 297–303. doi: 10.4103/ortho.IJOrtho_610_17
[03] Manganaro D, Dollinger B, Nezwek TA, et al. Anatomy, Bony Pelvis and Lower Limb, Foot Joints. [Updated 2019 Aug 18]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2019 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK536941/
[04] Durall C. J. (2011). Examination and treatment of cuboid syndrome: a literature review. Sports health, 3(6), 514–519. doi: 10.1177/1941738111405965
[05] Bishop C, Arnold JB, May T. Effects of Taping and Orthoses on Foot Biomechanics in Adults with Flat-Arched Feet. doi: 10.1249/MSS.0000000000000807
6. Sports Health. 2011 Nov; 3(6): 514–519.
7. How To Treat Cuboid Syndrome in Athlete – Podiatrytoday – Volume 17 – Issue 10 – October 2004 (By Mark A. Caselli, DPM, and Nikiforos Pantelaras, DPM)
8. https://pdfs.semanticscholar.org/4b49/46e860ec6216a362f3ff9193d10664f59eca.pdf