Cuboid syndrome is a condition caused by an injury to the joints and ligaments surrounding the cuboid bone. The cuboid bone is one of the seven tarsal bones in the foot. The cuboid syndrome causes pain on the lateral side of the foot which is the side of the little toe. The cuboid syndrome causes sharp pain on the outer side, and possibly underside, of the foot. The pain does not usually spread to the rest of the foot or leg. It often starts quite suddenly and lasts throughout the day. Pain can worsen with standing or walking and can make walking on the foot impossible.
Symptoms of a cuboid fracture include bruising, tenderness, swelling, lateral foot pain, instability, and difficulty with weight-bearing. Cuboid fractures have the potential to cause considerable deformity involving the foot arch, lateral column, and the function of the forefoot. Home remedies involve, resting, icing, compressing, and elevating the foot. If the pain perseveres, then it may be time to seek help from a medical professional. Two examples of possible treatments are the cuboid whip and the cuboid squeeze. Both options involve manipulating the cuboid bone back into place
Other Names
- Subluxed cuboid
- Locked cuboid
- Dropped cuboid
- Cuboid fault syndrome
- Lateral plantar neuritis
- Peroneal cuboid syndrome
Pathophysiology
- General
- Defined as a disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint
- Poorly understood conditions in both athletic and non-athletic populations
- Diagnostically challenging and easily misdiagnosed cause of lateral foot pain
Causes
- General
- The precise mechanism is not well understood
- Thought to arise from forceful eversion of the cuboid while the calcaneus is inverted, with resultant disruption of calcaneocuboid joint congruity
- Overuse
- In ballet dancers, from microtraumas to the ligamentous structures during maneuvers requiring maximum flexibility
- Plantar flexion and inversion
- Noted as a complication of a plantarflexion and inversion ankle injury
- Thought to represent the majority of cases
- Contributing factors
- Degree and direction of the force of the peroneus longus
- Position of the subtalar joint
- Overpronation of foot
- Lateral Ankle Sprain
- Jennings et al: 6.7% of patients with lateral ankle sprains also have cuboid syndrome[1]
- Cuboid
- Articulates with calcaneus (proximal), lateral cuneiform (medial), and metatarsals 4 and 5 (distal)
- Stabilizes calcaneocuboid joint, supports lateral column and functions as fulcrum during contraction of peroneus longus
- Peroneus Longus
- Tendon forms a sling around lateral, plantar aspects of the cuboid assists with calcaneocuboid stabilization
- Sports
- Ballet Dancers[2]
- Extrinsic
- Improperly constructed foot and ankle orthotics
- Uneven running terrain
- Faulty shoe construction
- Intrinsic
- History of Lateral Ankle Sprain
- Foot Pronation
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Talus Fracture
- Calcaneus Fracture
- Traumatic Navicular Fracture
- Cuboid Fracture
- Cuneiform Fracture
- Metatarsal Fracture
- Fifth Metatarsal Fracture
- Toe Fracture
- Hallux Sesamoid Fracture
- Stress Fractures
- Navicular Stress Fracture
- Metatarsal Stress Fracture
- Other Osseous
- Tarsal Coalition
- Accessory Navicular Syndrome
- Traumatic/ Acute
- Dislocations & Subluxations
- Toe Dislocation
- Lisfranc Injury
- Chopart Complex Injury
- Cuboid Syndrome
- Muscle and Tendon Injuries
- Posterior Tibial Tendon Dysfunction
- Peroneal Tendonitis
- Tibialis Anterior Tendinopathy
- Flexor Hallucis Longus Tendinopathy
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Subungual Hematoma
- Subungual Exostosis
- Nail Bed Laceration
- Onychocryptosis (Ingrown Toenail)
- Onychodystrophy
- Paronychia
- Onychomycosis
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin’s Disease)
- Calcaneal Apophysitis (Sever’s Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Symptoms
Cuboid syndrome causes pain on the lateral side of the foot which is the side of the little toe. A person often feels pain around the middle of the foot, or at the base of the fourth and fifth toes. It is often hard to tell exactly where this pain comes from, which makes cuboid syndrome challenging to diagnose.
Diagnosis
Local tenderness to direct palpation of the cuboid bone following foot injury may suggest cuboid fracture.[3]
- History
- They may have a history of an acute injury following an ankle sprain, or overuse following repetitive microtrauma
- Patients usually describe lateral foot pain at the site of the cuboid
- The pain may radiate into the plantar medial arch, fourth metatarsal
- Pain is worse with weight-bearing, during the toe-off part of the gait cycle
- Physical Exam: Physical Exam Foot
- On inspection, swelling, redness, and ecchymosis may be present
- If severe, a slight sulcus may be visible over the dorsum of the cuboid and a lump on the plantar surface[4]
- Subtle forefoot valgus may also be noted
- The patient will be tender directly over the cuboid
- There may also be tenderness along the peroneus longus tendon
- There may also be warmth, induration
- Range of motion is typically normal or slightly diminished
- Pain may be made worse with passive inversion and active, resisted plantar flexion and eversion
- Gait is antalgic
- Special Tests
- Tarsometatarsal Glide Test
- Midtarsal Glide Test
- Midtarsal Adduction Test: stabilize ankle and subtalar joint, apply adduction force
- Midtarsal Supination Test: stabilize ankle and subtalar joint, apply supination force
- Dorsal Plantar Cuboid Shear Test: cuboid is passively translated dorsally or plantarally
Radiographs
- Standard Radiographs Foot
- Typically normal
- Disruption or subluxation is minor and not typically radiographically evident
CT
- The diagnostic value for the cuboid syndrome is limited
- It May be useful to exclude another diagnosis
MRI
- The diagnostic value for the cuboid syndrome is limited
- It May be useful to exclude another diagnosis
Treatment
Nonoperative
- Indications
- Vast majority of cases
- Cuboid Manipulation
- Two techniques are described: the ‘cuboid whip’ and ‘cuboid squeeze’
- Physical Therapy
- Emphasis on stretching the gastrocnemius, soleus, hamstring, and/or peroneus longus
- Strengthening the intrinsic and extrinsic foot muscles
- Useful to prevent recurrence
- Arch Taping with Kinesiology Tape
- Orthotic Padding
- Cuboid padding
