Cuboid Syndrome
by Gary Prant, D.P.M.
The cuboid syndrome is a subluxation or disruption of the cuboid bone
which lies on the outside of the foot. The disruption of this bone causes
irritation to the surrounding soft tissue structures that attach to this bone.
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This is a condition seen more often in athletes but it can occur in anyone. The most common cause of cuboid syndrome is turning the foot down and in at the ankle. Many times this happens when you step off a curb wrong. Sometimes an ankle sprain happens and sometimes if you twist your foot just right or if your ligaments are loose, the cuboid dislocates. When the cuboid dislocates it is very subtle and sometimes impossible to see on a standard x-ray. However, with the video fluoroscan x-ray the problem can sometimes be seen. There are also a few clinical tests I use to test for cuboid syndrome. While cuboid syndrome is not that common, it is not rare. I actually see a fair number of cases referred to me where the person has been suffering for a long time with an undiagnosed cuboid syndrome. The longer the condition has been present the longer it takes to cure.
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Patients typically complain of pain that develops rapidly, or in some instances gradually after a prolonged period of time following an inversion sprain of the ankle. The pain is usually directly over the cuboid bone, but may also travel underneath the foot into the arch. Surrounding structures may also be painful. Pain may be present weight bearing and nonweight bearing but certainly it becomes more difficult to walk.
The diagnosis of cuboid syndrome often cannot be made by use of standard x-ray or MRI because the subluxation is so minor that those imaging studies would be of little value, however in any case an x-ray is indicated to rule out other pathology particularly fracture. Cuboid syndrome responds well to conservative treatment with the primary treatment being manipulation of the cuboid bone back into place followed by a strapping of the foot and a cuboid pad. In some cases relief from pain is instantaneous. Other forms of treatment include physical therapy, microcurrent therapy and padding the shoe in a certain manner to force the cuboid back into position. An orthotic with a built in cuboid pad can be very helpful in maintaining the position of the cuboid. Treatment may require several manipulations because the cuboid may not stay in place once it is relocated. I find that most people require about 5 weeks and about three manipulations before the ligaments around the cuboid tighten up and hold the cuboid bone comfortably in place.
