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Do you have lateral foot pain thinking it’s an ankle sprain but hasn't improved? Well, it might be cuboid syndrome. Cuboid syndrome is rare, accounting for only 4% of all foot injuries. Due to it's rarity, there is a lack of education and understanding around the injury and it is often misdiagnosed as an ankle sprain or planter neuritis.
Cuboid syndrome is characterized by mid-lateral foot pain that results from a disruption in the arthrokinematics of the calcanealcuboid joint (CC joint). It is also referred to by other names in the literature like subluxed cuboid, locked cuboid, dropped cuboid, or cuboid fault syndrome.
The cuboid bone is crucial during the gait cycle as it articulates with five other bones in the foot, namely, 4th and 5th metatarsals, cuneiform, navicular, and calcaneus (heel bone). During the push-off portion of gait, it works in tandem with the navicular bone, moving slightly to absorb load through your foot. Even though it is closely linked with the navicular, the cuboid bone articulates most with the calcaneus, making a very stable joint with multiple ligament and tendon attachments.
The primary function of the cuboid bone is to act as a lever or pulley for a tendon on the lateral ankle called the peroneus longus. The cuboid's position allows for optimal force production of the peroneus longus, similar to the relationship between your knee cap (patella) and quadriceps muscle. Therefore, the cuboid bone has a unique and essential role in the foot.
How does cuboid syndrome occur?
Ankle Sprains
Cuboid syndrome most often occurs after an ankle sprain, specifically in forced plantar flexion and inversion. During an ankle sprain, there is a reflex contraction of the lateral ankle muscles and tendon (peronus longus in particular), which essentially pulls on the cuboid bone causing it to become irritated or marginally displaced. This is commonly seen in ballet dancers.
Overuse
Overuse injuries, though less common, can also affect the cuboid bone, joint capsule, and surrounding ligaments. Repeated microtraumas over time can lead to irritation and potential displacement of the cuboid bone, causing pain and discomfort.
What factors make you more at risk for Cuboid Syndrome?
Wearing poorly constructed orthotics or ill-fitting shoes
Excessive body weight
Mid foot instability / hypermobility
High Intensity and Frequency of Exercise
Training on unstable surfaces
History of Ankle Sprains
Excessive arch pronation - this puts more pressure on the peroneus longus tendon
What are the symptoms of Cuboid Syndrome:
Cuboid syndrome presents similarly to a lateral ankle sprain, with:
diffuse pain across the lateral foot mainly around the CC joint sometimes spreading to the mid foot.
Swelling and a look of fullness may be present on the lateral foot.
TOP along the peroneus longus tendon, dorsal and plantar aspects of the cuboid bone
Ankle range of motion may be limited due to pain
Resisted ankle inversion and eversion may be painful
An antalgic gait, with more pronounced pain during push off
High impact like hopping or running may elicit symptoms
Symptoms typically improve with rest
How to treat cuboid syndrome:
Manipulation:
A practitioner (physiotherapist / chiropractor) can perform a cuboid whip, which is a high velocity thrust that is meant to adjust or shift the cuboid to its ideal position. The clinician and patient may hear or feel a popping sound during the “whip” action confirming that the technique was successful. Patients may feel slight discomfort after the manipulation with pain relief in the following days. Several manipulations may be required for full resolution of symptoms.
Taping
To prevent recurrence of cuboid pain, taping the cuboid can be helpful. A common technique is called a cuboid sling where tape is applied to the bottom of the foot, wrapping over and around the cuboid bone and attaching to the medial ankle. This sling supports the cuboid bone and prevents further irritation of the surrounding joint capsule, ligaments, and tendons.
Myofascial Release
Releasing the peroneal muscles can be helpful as there may be muscle tension after an ankle sprain and a tight peroneus longus could restrict the movement of the cuboid bone making it harder to perform a successful “cuboid whip”.
Strengthening
Strengthening the tibialis posterior and intrinsic muscles of the foot can be helpful. Exercises could include a banded toe flexion, active arch lifts, tibialis posterior calf raises. This is clearly not an exhaustive list, but suggestions on how to get started.
Cuboid Pad
A small pad of a thickness of ¼ to ⅛ mm can be used on the medial plantar aspect of the cuboid to prevent further rotation and irritation during gait and exercise. You typically see cuboid pads in custom orthotics.
If you are struggling with lateral foot pain and think you may have cuboid syndrome, seek out your local physiotherapist or bring it up at your next appointment. It's worth checking to make sure you a have a speedy recovery. If you are looking a physiotherapist in the New Westminster area visit our website royalcityphysio.com or contact us at 604-553-1203.
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