Cuboid Syndrome is a common cause of lateral foot pain i.e. pain on the outer side of the foot.
Whilst fairly simple to treat, it is often misdiagnosed so symptoms can last for a long time. It particularly affects athletes such as ballet dancers and runners.
The condition develops when the cuboid bone (one of the small bones in the foot) subluxes i.e. partially dislocates.
This may happen suddenly due to an injury such as an ankle sprain, or develop gradually overtime from repetitive tension through the bone and surrounding structures.
Here, we will look at the common causes of cuboid syndrome, how it presents, diagnosis and the best treatment options.
The cuboid is one of the small bones
on the outer side of the midfoot. It attaches to the heel bone
(calcaneus) via a number of strong ligaments and a joint capsule forming
the calcaneocuboid joint.
Trauma to the foot, be it a sudden injury or gradually repetitive forces may damage the supporting soft tissues causing the cuboid bone to move out of its usual position. It can then act like a block, limiting the movement of the surrounding bones in the foot.
Other terms commonly used are cuboid subluxation, blocked cuboid, dropped cuboid, lateral plantar neuritis and cuboid fault syndrome.
There are three main causes of Cuboid Syndrome:
Cuboid Syndrome classically presents with:
Diagnosing a subluxed cuboid can be difficult and cuboid syndrome is often misdiagnosed. Imaging studies such as x-rays, MRIs and CT scans often fail to show cuboid subluxation but they can be useful for ruling out other causes of pain.
There is no conclusive test for Cuboid Syndrome but your doctor will usually assess to see if there is pain and stiffness on palpation of the bone (when they press firmly on the cuboid through the sole of your foot).
They may also move your foot inwards and outwards to see if that elicits pain or get you to try and hop.
Some health professionals may use the midtarsal adduction test or midtarsal supination test to assess for the condition.
Cuboid Syndrome often goes undiagnosed with ankle sprains. If symptoms continue more than three months following an inversion sprain, cuboid subluxation should be considered.
The best treatment options for Cuboid Syndrome are:
Balance exercises should also be introduced once cuboid pain symptoms have settled. If balance work is ignored, you are at increased risk of further foot and ankle injuries such as ankle sprains in the future.
Exercises for cuboid syndrome should be started as soon as possible, gradually progressed as symptoms allow and continued until full function of the foot is restored.
The quicker treatment commences following a cuboid subluxation, the quicker full function will be restored. Chronic (long-term) cases, will take longer to heal.
The most successful treatment for a subluxed cuboid is to have the bone relocated back into its proper position.
A health professional such as a doctor, physical therapist or podiatrist will perform a manipulation, which is a high velocity (quick) small amplitude thrust to the cuboid bone to relocate it. This should only ever be carried out by a trained professional. The symptoms of cuboid syndrome will usually settle immediately if the manipulation is done correctly.
Manipulations for cuboid syndrome are not suitable if you suffer from gout, bone disease, fracture, rheumatoid arthritis or nerve or vascular problems.
Following successful manipulation, other treatments will help to keep the bone in the correct position and to treat any lingering symptoms.
Taping of the foot and ankle is often used to support and stabilize the bones in the foot with cuboid syndrome. Medical tape is used to support and stabilize the bones in the foot and hold the cuboid in place while the surrounding soft tissues heal. Taping should allow you to walk without pain.
Ice therapy can help to reduce pain and inflammation from cuboid syndrome. Place an ice pack or bag of frozen veg wrapped in a tea towel over the outside of the foot for ten minutes at a time.
To find out more visit the Ice Therapy section including how to safely and effectively use ice.
It is important to rest from aggravating activities while the foot heals from cuboid subluxation. This may require the use of crutches for a short period of time to keep weight off the injured foot.
If over-pronation of your foot (i.e. flat feet) is thought to have been a contributing factor to developing cuboid syndrome, you should be given orthotic insoles to wear in your shoes to correct your foot position to relieve tension on the peroneus longus tendon and support the foot bones and arches.
You may also be given a small foam wedge to wear in your shoe which helps to support the cuboid bone in the correct position.
There are a number of other causes of pain on the outside of the foot other than Cuboid Syndrome. If this is not sounding like your problem, visit the side foot pain or foot pain diagnosis sections for helping working out what is causing your pain.
*Stats Source: Sports Health Journal
Page Last Updated: 2019-06-14
Next Review Due: 2021-06-14