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 Cuboid
syndrome refers to the disruption of the normal function of the calcaneal-cuboid
joint (CC joint). Disruption of the CC joint is often called subluxation. Cuboid
syndrome is somewhat obscure and poorly defined in the literature. When
conditions are poorly defined in the literature, this 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 be found in the
literature described as a sequella of inversion sprains of the ankle.
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.
The onset of cuboid syndrome varies and can be abrupt (most common) or
insidious in onset. Pain is typically site specific to the plantar lateral
cuboid. Indurated (hard) edema may be found. Bruising is uncommon.
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 in the region
of the CC joint (see differential diagnosis below).
Treatment Of Cuboid Syndrome
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 many, 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.
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