Condition Spotlight: Cuboid Syndrome

What is Cuboid Syndrome?

Cuboid syndrome is a condition where the cuboid bone of the foot moves out of its proper alignment with the calcaneus (heel bone).

This subluxation/dislocation of the cuboid can cause pain to the surrounding joints and ligaments.

What does Cuboid Syndrome feel like?

Those suffering from cuboid syndrome will often state that they experience either a dull ache or a sharp pain in the cuboid region or lateral aspect (outer side) of the foot.

The pain typically worsens with activity or when weight bearing and does not always resolve with rest, thought this depends on the extent of the injury.

In some cases, swelling may also be present.

What causes Cuboid Syndrome?

Cuboid syndrome can be caused by a number of factors including:

Acute or repeated ankle sprains

Inversion or lateral ankle sprains place a lot of stress on the lateral (outside) part of the foot and there are often injuries in this area as well as at the ankle.

Pes planus foot type (flat feet)

Those with flat feet may have other bones within the midfoot out of their optimal alignment. This can therefore affect the alignment of other bones within the feet.

Inappropriate footwear

Shoes that do not fit properly or are inappropriate for the activity can cause pain and pressure to not only the cuboid region, but also to the rest of the foot.

Walking/training on uneven surfaces

Uneven surfaces force the feet to adapt and change their alignment to be able to keep you upright and attempt to avoid injury. Over time, this may start to cause pain.

Acute injury 

Landing awkwardly on the cuboid bone or outside of the foot may cause pain and dislocation of the cuboid

Tight peroneals

The peroneals are a group of muscles that sit on the lateral aspect (outside) of the lower leg and have attachments within the feet.

These muscles are responsible for everting the foot.

Tightness of these muscles can place pressure on the midfoot, in particular where the peroneus brevis muscle attaches onto, which is close to the cuboid.

Tightness of these muscles can result in a pulling force on the lateral aspect of the foot.

Who does Cuboid Syndrome affect?

Cuboid syndrome can affect anyone in the adult population.

However, it is most popular in those who participate in high impact activities such as running, dancing, football and so on.

It is common in those with a pes planus foot type (flat feet) as the cuboid bone is often compressed. It is also quite common in those who suffer with peroneal tendinopathy or repeated inversion ankle sprains.

How is Cuboid Syndrome Diagnosed?

Cuboid syndrome is often diagnosed through an assessment of the range of motion of the midfoot joints, as well as through palpation of the cuboid.

If the pain is significant, we will also often refer for an X-ray to rule out a fracture and to identify the presence of a dislocation.

How is Cuboid Syndrome treated?

Cuboid syndrome responds well to a variety of treatments. These can include:

Mobilisation and manipulation of the cuboid bone

This can include methods known as the ‘cuboid whip’ and the ‘cuboid squeeze’, which both involve manipulating the bone back into its original position. This can relieve symptoms almost immediately.

Reduce tightness of the peroneal muscles

Tightness of the peroneal muscles is a risk factor for cuboid syndrome. This can be addressed in a number of ways including massage and dry needling, as well as a stretching of this muscle group.

Taping

Taping can assist with both the alignment of the foot, as well as providing compression and support to the cuboid itself. The type of taping applied will depend on your foot type and function and aims to offload the cuboid area in the short term.

Padding

This may be applied to the insole of your shoe to provide cushioning and support to the foot.

NSAIDs (non steroidal anti-inflammatory medication)

This includes ibuprofen/nurofen. Taking this medication will help to relieve pain and inflammation in the affected area. Always follow the directions on the package and consult your doctor to check that you are safe to take this type of medication.

Orthotics 

Orthotics will help to support the feet as a whole and to redistribute the pressure away from painful areas. A thorough assessment will be conducted to determine whether orthotics will be the best treatment option for you. Assessment will include testing the range of motion and strength within the feet, as well as standing, walking and running assessments. Based on these assessments, we can determine if orthotic therapy is required.

Strengthening program

Strengthening the muscles that run into the foot from the lower leg will assist with overall balance and strength and help with preventing future injury. We will create a tailored strengthening program based on your current strengths and weaknesses to reduce your risk of future injury and to assist with managing your pain.

Moon boots

Moon boots are used in severe cases where it is very painful to place any weight through the foot. They assist with reducing pressure on the foot and allowing the joints and soft tissue to heal without anya unnecessary pressure being placed upon them.

If you have Cuboid Syndrome

If you suspect that you might be suffering from cuboid syndrome, or you’re experiencing any form of pain or discomfort in your feet, toes or lower limbs, book in to see us at our podiatry clinic here in Watsonia.

Based in Melbourne’s North-East suburbs, our experienced and highly qualified team is here to help not only relieve you of this pain but also find the cause so we can find a long term solution!

Book in to see us by calling us on 03 9432 2689 or making an appointment online here.

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