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Cuboid Syndrome
From WikiSM
Contents
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
- Cuboid Fracture is discussed separately
History
Epidemiology
- Epidemiology is poorly understood
- Found in 17% of ballet dancers with foot or ankle injuries[1]
- Found in 6.7% of patients with plantar flexion/ inversion ankle sprains[2]
Pathophysiology
- 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
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[2]
- Plantar flexion and inversion
- Noted as a complication of a plantar flexion and inversion ankle injury[1]
- 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
- Lateral Ankle Sprain
- Jennings et al: 6.7% of patients with lateral ankle sprains also have cuboid syndrome[1]
Pathoanatomy
- 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
Risk Factors
- Sports
- Ballet Dancers[2]
- Extrinsic
- Improperly constructed foot and ankle orthotics
- Uneven running terrain
- Faulty shoe construction
- Intrinsic
- History of Lateral Ankle Sprain
- Foot Pronation
Differential Diagnosis
- Fractures & Osseous Disease
- Traumatic/ Acute
- Stress Fractures
- Other Osseous
- Dislocations & Subluxations
- Muscle and Tendon Injuries
- Ligament Injuries
- Plantar Fasciopathy (Plantar Fasciitis)
- Turf Toe
- Plantar Plate Tear
- Spring Ligament Injury
- Neuropathies
- Mortons Neuroma
- Tarsal Tunnel Syndrome
- Joggers Foot (Medial Plantar Nerve)
- Baxters Neuropathy (Lateral Plantar Nerve)
- Arthropathies
- Hallux Rigidus (1st MTPJ OA)
- Gout
- Toenail
- Pediatrics
- Fifth Metatarsal Apophysitis (Iselin's Disease)
- Calcaneal Apophysitis (Sever's Disease)
- Freibergs Disease (Avascular Necrosis of the Metatarsal Head)
Clinical Features

Local tenderness to direct palpation of the cuboid bone following foot injury may suggest cuboid fracture.[3]
- 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[4]
- 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
- Tarsometatarsal Glide Test
- Midtarsal Glide Test
- Midtarsal Adduction Test: stabilize ankle and subtalar joint, apply adduction force
- Midtarsal Supination Test: stabilize ankle and subtalar joint, apply supination force
- Dorsal Plantar Cuboid Shear Test: cuboid is passively translated dorsally or plantarally
Evaluation
Radiographs
- Standard Radiographs Foot
- Typically normal
- Disruption or subluxation is minor and not typically radiographically evident
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
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
Operative
Rehab and Return to Play
Rehabilitation
- Needs to be updated
Return to Play/ Work
- Needs to be updated
Complications and Prognosis
Prognosis
- Physical therapy
- Patients have responded well to manipulation with the "cuboid whip" in small studies[5]
Complications
- Needs to be updated
See Also
- Internal
- External
- Sports Medicine Review Foot Pain: https://www.sportsmedreview.com/by-joint/foot/
References
- ↑ 1.0 1.1 1.2 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.
- ↑ 2.0 2.1 2.2 Marshall, Peter, and William G. Hamilton. "Cuboid subluxation in ballet dancers." The american journal of sports medicine 20.2 (1992): 169-175.
- ↑ Angoules, Antonios G., et al. "Update on diagnosis and management of cuboid fractures." World journal of orthopedics 10.2 (2019): 71.
- ↑ 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.
- ↑ 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:
4 October 2022 12:38:27
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