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Cuboid Syndrome

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Summary

Cuboid syndrome refers to the disruption (subluxation) of the normal function of the calcaneal-cuboid joint (CC joint). Cuboid syndrome isbones_of_the_foot somewhat obscure and poorly defined in the literature. Poorly defined literature means that there is a lack of consensus among doctors as to the etiology (reason for the condition) and the treatment. Cuboid syndrome can also describe a sprain of the CC joint or any of the supporting structure contiguous to the CC joint. These structures include the calcaneo-cuboid ligaments and peroneus longus tendon. Cuboid syndrome is also referred to as a subluxed cuboid.

Symptoms

  • Lateral midfoot pain, painful to touch
  • Pain with onset of weight bearing that increases with the duration of time spent walking
  • No ecchymosis (bruising) found
  • Little to no edema (swelling) found
  • The onset of pain may be abrupt or insidious

Pain is significant when weight is first applied to the foot. Pain increases with the toe off phase of gait as the weight of the body and load from the calf muscle are delivered to the lateral (outside) column of the foot.

Description

lateral_column_of_the_footCuboid syndrome describes the symptoms experienced when the calcaneal-cuboid joint is unable to carry sustained load. The calcaneal-cuboid joint (CC joint) is part of what's referred to as the lateral column of the foot. The lateral column is the primary load bearing section of the foot that transfers load from the heel to the forefoot following the heel strike phase of gait. The CC joint functions in conjunction with the talo-navicular joint (TN joint) and the subtalar joint (STJ) to adapt to uneven surfaces and transfer load from the calf to the forefoot.

 

Causes and contributing factors

Ankle sprains are the most common contributing factor to cuboid syndrome.  Additional contributing factors include pes cavus (high arch), metatarsus adductus and equinus. 

Differential diagnosis

As a syndrome, it should be recognized that the symptoms of cuboid syndrome may be the result of one or more conditions that affect normal function of the calcaneal-cuboid joint.  These conditions include;

Bone contusion
Calcaneal stress fracture
Compression neuropathy of the sural nerve
Cuboid fracture
Gout
Peroneal tendonitis
Partial peroneal tendon rupture
5th metatarsal avulsion fracture
Os peroneum
Sinus tarsi syndrome
Tarsal coalition
Tarsitis

Treatment

The diagnosis of cuboid syndrome is made based upon the location and onset of pain. Plain x-ray should be used to differentiate cuboid syndrome from fractures. MRI is also helpful to define soft tissue problems that occur contiguous to the CC joint.

Cuboid syndrome, when due to subluxation of the calcaneal-cuboid joint, is treated by reducing (realigning) the subluxation of the CC joint and stabilizing the reduction. It is believe by some, but not all practitioners, that reduction of the subluxation can be accomplished by manipulating the joint. Manipulation is performed with the patient in a prone (face down) position. The doctor cradles the foot in his/her hands and places both thumbs beneath the CC joint. The CC joint is then manipulated by a forceful movement, moving the leg at the knee and the ankle while applying pressure with the thumbs at the plantar (bottom) aspect of the CC joint. This procedure is called a cuboid whip.

Reduction of the subluxation can be maintained with taping and padding. Padding of the lateral sole is used to maintain the reduction of the CC joint and limit supination (rolling to the outside of the foot). Lateral sole wedges can be placed in the shoe or applied to the outer sole of the shoe at a shoe repair shop. Rest, ice, compression and elevation (RICE) is used as a first line treatment of cuboid syndrome. The use of oral NSAID medications is also common. Occasionally, cortisone injections may be helpful in reducing inflammation associated with the subluxation of the CC joint. Patients are instructed to avoid going barefoot or wearing shoes with low heels. Heel lifts worn within the shoe can also be helpful. Once the acute symptoms are resolved, prescription orthotics (arch supports) are helpful in preventing a recurrence of cuboid syndrome.

The response to treatment of cuboid syndrome depends upon the etiology and onset of symptoms. Acute onset of cuboid syndrome, say from an ankle sprain, may respond dramatically to manipulation. If cuboid syndrome is due to chronic, excessive intrinsic load (CT Band Syndrome), treatment such as manipulation may be less effective and take longer to see results.

When to contact your doctor

Symptoms of cuboid syndrome that do not respond to 2 weeks of conservative care should be evaluated by your podiatrist or orthopedist.

References

References are pending.

Author(s) and date

Dr. Jeffrey OsterThis article was written by Myfootshop.com medical director Jeffrey A. Oster, DPM.

Competing Interests - None

Peer Reviewed - This article is peer reviewed by an open source editorial board.  Your comments and suggestions to improve this paper are appreciated.

Cite this article as: Oster, Jeffrey.  Cuboid syndrome  http://www.myfootshop.com/article/cuboid-syndrome

First published online: January 1, 2000.  Most recently updated 12/10/13.
 

Creative Commons License  Cuboid Syndrome by Myfootshop.com is licensed under a Creative Commons Attribution-NonCommercial 3.0 Unported License.

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