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Cuboid Syndrome

From WikiSM

Other Names

  • Subluxed cuboid
  • Locked cuboid
  • Dropped cuboid
  • Cuboid fault syndrome
  • Lateral plantar neuritis
  • Peroneal cuboid syndrome

Background

  • This page refers to a syndrome generally thought to be due to subluxation of the Cuboid

History

  • First case published in 1952 by B.S. Durall[1]

Epidemiology

  • Epidemiology is poorly understood
  • Found in 17% of ballet dancers with foot or ankle injuries[2]
  • Found in 6.7% of patients with plantar flexion/ inversion ankle sprains[3]

Introduction

Posterolateral illustration of the cuboid[4]

General

  • Defined as a disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint
  • Poorly understood condition in both athletic and non-athletic populations
  • Diagnostically challenging and easily misdiagnosed cause of lateral foot pain
  • Treatment is generally non-surgical with good outcomes when treated appropriately

Etiology

  • General
    • Precise mechanism is not well understood
    • Thought to arise from forceful eversion of the cuboid while the calcaneus is inverted, with resultant disruption of calcaneocuboid joint congruity
  • Overuse
    • In ballet dancers, from microtraumas to the ligamentous structures during maneuvers requiring maximum flexibility[3]
  • Plantar flexion and inversion
    • Noted as a complication of a plantar flexion and inversion ankle injury[2]
    • Thought to represent the majority of cases
  • Contributing factors
    • Degree and direction of the force of the peroneus longus
    • Position of the subtalar joint
    • Overpronation of foot

Associated Conditions

Anatomy of the Cuboid

  • Articulates with calcaneus (proximal), lateral cuneiform (medial), and metatarsals 4 and 5 (distal)
  • Stabilizes calcaneocuboid joint, supports lateral column and functions as fulcrum during contraction of peroneus longus
  • Peroneus Longus: tendon forms a sling around lateral, plantar aspects of the cuboid assists with calcaneocuboid stabilization

Anatomy of the Calcaneocuboid Joint

Risk Factors

  • Sports
    • Ballet Dancers[3]
  • Extrinsic
    • Improperly constructed foot and ankle orthotics
    • Uneven running terrain
    • Faulty shoe construction
  • Intrinsic

Differential Diagnosis

Differential Diagnosis Foot Pain

Clinical Features

Local tenderness to direct palpation of the cuboid bone following foot injury may suggest cuboid fracture.[5]
Midtarsal Adduction Test

History

  • They may have a history of an acute injury following an ankle sprain, or overuse following repetitive microtrauma
  • Patients usually describe lateral foot pain at the site of the cuboid
  • The pain may radiate into plantar medial arch, fourth metatarsal
  • Pain is worse with weight bearing, during toe-off part of gait cycle

Physical Exam: Physical Exam Foot

  • On inspection, swelling, redness and ecchymosis may be present
  • If severe, a slight sulcus may be visible over the dorsum of the cuboid and a lump on the plantar surface[6]
  • Subtle forefoot valgus may also be noted
  • The patient will be tender directly over the cuboid
  • There may also be tenderness along the peroneus longus tendo
  • There may also be warmth, induration
  • Range of motion is typically normal or slightly diminished
  • Pain may be made worse with passive inversion and active, resisted plantar flexion and eversion
  • Gait is antalgic

Special Tests

Evaluation

Lateral x-ray view demonstrating the subluxation of the calcaneocuboid joint. Fig. 3 Oblique x-ray view of the medial border of the fourth metatarsal not completely in line with the medial border of the cuboid bone.[7]
X ray (A) and CT scan (B) showing an isolated inferomedial dislocation of the cuboid without fracture[8]

Radiographs

CT

  • Diagnostic value for cuboid syndrome is limited
  • May be useful to exclude other diagnosis

MRI

  • Diagnostic value for cuboid syndrome is limited
  • May be useful to exclude other diagnosis

Classification

  • Not applicable

Management

Short Walking Boot

Nonoperative

  • Indications
    • Vast majority of cases
  • Cuboid Manipulation
    • Two techniques are described: the 'cuboid whip' and 'cuboid squeeze'
  • Physical Therapy
    • Emphasis on stretching the gastrocnemius, soleus, hamstring, and/or peroneus longus
    • Strengthening the intrinsic and extrinsic foot muscles
  • Useful to prevent recurrence
    • Arch Taping with Kinesiology Tape
    • Orthotic Padding
    • Cuboid padding
  • Immobilization if needed in short walking boot

Operative

  • Needs to be updated

Rehab and Return to Play

Demonstration of cuboid whip manipulation[9]
Illustration of cuboid squeeze technique[9]

Rehabilitation

  • Cuboid Whip
    • The clinician cups the dorsum of the patient’s forefoot
    • Place thumbs on the plantomedial aspect of the cuboid.
    • The atient’s knee is flexed 70° to 90°, the ankle is placed in 0° dorsiflexion
    • With the patient’s leg relaxed, the clinician abruptly “whips” the foot into inversion and plantarflexion
    • While delivering a low-amplitude, high-velocity thrust
    • A “pop” or shift may be heard and/or felt by the clinician and/or patient
  • Cuboid Squeeze
    • Slowly stretche the ankle into maximal plantarflexion and the foot and toes into maximal flexion
    • The cuboid is "squeezed" when the clinical feels the dorsal soft tissues relax
    • The cuboid squeeze may not be appropriate for patients who have a coincident lateral ankle sprain

Return to Play/ Work

  • General criteria[10]
    • Resolution of pain and restoration of anatomical alignment and functional stability of the cuboid
    • Full restoration of sport-specific skills and movement patterns
    • Use of protective taping, padding, or orthoses as needed

Complications and Prognosis

Prognosis

  • General[11]
    • Prognosis is good when condition is recognized and treated appropriately
    • Most patients experience rapid symptom resolution and return to full activity
  • Physical therapy
    • Patients have responded well to manipulation with the "cuboid whip" in small studies[12]

Complications

See Also

Internal

External

References

  1. ↑ Durall, B. S. "Cuboid Syndrome." Journal of the American Podiatry Association. 1952;42:34-35
  2. ↑ 2.0 2.1 2.2 Jennings, Jason, and George J. Davies. "Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series." Journal of orthopaedic & sports physical therapy 35.7 (2005): 409-415.
  3. ↑ 3.0 3.1 3.2 Marshall, Peter, and William G. Hamilton. "Cuboid subluxation in ballet dancers." The american journal of sports medicine 20.2 (1992): 169-175.
  4. ↑ Case courtesy of Craig Hacking, Radiopaedia.org, rID: 83347
  5. ↑ Angoules, Antonios G., et al. "Update on diagnosis and management of cuboid fractures." World journal of orthopedics 10.2 (2019): 71.
  6. ↑ Mooney, Maureen, and Lorrie Maffey-Ward. "Cuboid plantar and dorsal subluxations: assessment and treatment." Journal of Orthopaedic & Sports Physical Therapy 20.4 (1994): 220-226.
  7. ↑ Mazzotti, Antonio, et al. "Traumatic cuboid dislocation. the potential role of plantar ligaments integrity in facilitating reduction: a case report." JBJS Case Connector 11.2 (2021): e20.
  8. ↑ Sheahan, K., E. Pomeroy, and T. Bayer. "An isolated cuboid dislocation. A case report." International Journal of Surgery Case Reports 39 (2017): 1-4.
  9. ↑ 9.0 9.1 Durall, Chris J. "Examination and treatment of cuboid syndrome: a literature review." Sports Health 3.6 (2011): 514-519.
  10. ↑ Jennings, Jason, and George J. Davies. "Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series." Journal of orthopaedic & sports physical therapy 35.7 (2005): 409-415.
  11. ↑ Marshall, Peter, and William G. Hamilton. "Cuboid subluxation in ballet dancers." The american journal of sports medicine 20.2 (1992): 169-175.
  12. ↑ Jennings J., Davies G.J. (2005) Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. Journal of Orthopedic and Sports Physical Therapy 35(7), 409-415
Created by:
John Kiel on 10 October 2021 10:19:50
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Last edited:
26 February 2026 15:00:28
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