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Cuboid Syndrome

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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

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

Pathoanatomy


Risk Factors

  • Sports
    • Ballet Dancers[2]
  • Extrinsic
    • Improperly constructed foot and ankle orthotics
    • Uneven running terrain
    • Faulty shoe construction
  • Intrinsic

Differential Diagnosis


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

Evaluation

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

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


References

  1. 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. 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.
  3. Angoules, Antonios G., et al. "Update on diagnosis and management of cuboid fractures." World journal of orthopedics 10.2 (2019): 71.
  4. 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.
  5. 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
Authors:
Last edited:
4 October 2022 12:38:27