Written By: Chloe Wilson BSc(Hons) Physiotherapy
Reviewed By: FPE Medical Review Board
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:
The most common injury that causes cuboid subluxation is an inversion sprain of the ankle. This is when the foot and heel bone are forced inwards while the cuboid is forced outwards.
This inwards twisting damages the soft tissues which support the bone in place causing it to partially dislocate. In this instance, cuboid pain usually comes on suddenly.
Another common cause of cuboid syndrome is repetitive strain. The peroneus longus muscle runs down the outer side of the lower leg attaching on to the outer side of the foot. Tension placed through this muscle from repetitive activities such as ballet (pointing), jumping and running may cause excessive traction on the cuboid bone causing it to sublux.
In this case, symptoms come on gradually over time and often fluctuate.
Studies have shown that a majority of people suffering from cuboid subluxation have over-pronated feet i.e. flat feet.
Common symptoms of Cuboid Syndrome include:
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 cuboid syndrome test 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:
Cuboid syndrome exercises are a vital part of treatment and should incorporate a selection of:
Cuboid syndrome exercises should be started as soon as possible and performed daily, 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 a suitable treatment if you suffer from gout, bone disease, fracture, rheumatoid arthritis or nerve or vascular problems.
Following successful manipulation, other cuboid syndrome treatments will help to keep the bone in the correct position and to treat any lingering symptoms.
Taping can be a useful cuboid syndrome treatment tool. 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.
Correct taping for cuboid syndrome should allow you to walk without pain. Your physio should be able to teach you how to apply cuboid syndrome taping correctly.
Ice therapy can help to reduce pain and inflammation as part of your cuboid syndrome treatment. 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.
Rest from aggravating activities is a really important part of cuboid syndrome treatment. In most cases, 6-8 weeks of rest is recommended before returning to sports or any challenging activities. In some cases, people are advised to use crutches for a short period of time to keep weight off the subluxed cuboid completely.
Specially designed shoe inserts can be a helpful part of cuboid syndrome treatment. 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.
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Page Last Updated: 03/16/23
Next Review Due: 03/16/25
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*Stats Source: Sports Health Journal