Cuboid Syndrome: symptoms and treatments

What is Cuboid Syndrome?

The cuboid is a small midfoot bone that connects the outer metatarsals to the heel bone. It’s joined to the heel bone by several ligaments and a joint capsule. The cuboid helps your foot to flex and navigate the subtle mechanics of walking, dancing, balancing, and every on-foot activity.

Cuboid syndrome is what happens when the bone becomes partially dislocated from the joint. This can happen gradually after overuse and repetitive strain, or it can dislocate suddenly during a trauma, such as an ankle sprain.

Causes of Cuboid Syndrome

There are two primary ways that a patient can develop cuboid syndrome.

Injury. The twisting motion of the foot that can sprain your ankle can also dislocate the cuboid bone. The most common type of injury to cause this is called an inversion sprain. An inversion sprain occurs when the foot overturns on its outer edge, forcing the sole of the foot up and inward and overstretching the ligaments of the outer foot. You will feel a sharp, sudden, acute pain in the outer mid-foot.

Overuse. The muscle that connects the outside of your shin to your outer foot is called the peroneus longus. This muscle can be pulled excessively through overuse and repeated strain from activities like running, jumping, or dancing on-pointe (in ballet). The tension in the muscle can pull on the cuboid, causing dislocation over time. You may feel gradually worsening pain in the outer mid-foot as the injury progresses, or the pain may come and go.

Additionally, cuboid syndrome is more common among people with overpronation, also known as flat feet. As many as 80% of cuboid injuries occur in flat-footed patients.

Cuboid Syndrome Symptoms

Cuboid syndrome can often be mistaken for other types of foot pain. Patients with cuboid syndrome commonly experience:

• Redness and swelling in the outer mid-foot
• Tenderness to the touch
• Pain on the outside of the foot, which can travel to the ankle or toes
• Pain that worsens when bearing weight
• Pain that is worse first thing in the morning
• Pain when jumping, hopping, changing directions quickly, or walking on inclines
• Limping and difficulty walking
• Weakness when stepping off the ground

Diagnosing Cuboid Syndrome

Cuboid syndrome is difficult to diagnose. The dislocation of the joint doesn’t always show up on an X-ray, MRI, or CT scan. However, your foot and ankle specialist can use advanced imaging to rule out other possible causes of pain. Your specialist may press on the tender area and flex your foot to the in and out to see what types of motion cause pain.

Almost 7% of ankle sprains are accompanied by a cuboid injury, but this often goes undiagnosed and untreated. If you have lingering pain following an ankle sprain after 2-3 months, call your foot and ankle specialist to be evaluated for cuboid syndrome.

Cuboid Syndrome Treatment

Cuboid syndrome can’t be treated solely at home. Your foot and ankle specialist will use a technique called “manipulation” to pop the joint back in place with a quick, forceful hand maneuver. Never try to do this on your own. Your doctor may not recommend manipulation for patients who have a fracture, bone disease, gout, arthritis, nerve problems, or vascular problems.

After successful manipulation, your foot should start to feel better immediately. You can also ease symptoms and protect the foot from further injury by:

• Icing. Wrap a small bag of ice in a thin washcloth and place it over your mid-foot for 10-15 minutes, three times each day. Icing can help with pain and swelling.
• Resting. Keep weight off your foot for a few days after manipulation. You may use crutches to walk while your foot heals. Ask your foot and ankle specialist when you can expect to return to your normal activities.
• Taping. Wrap the inside of your foot, around the sole and over the top, with athletic tape to support the bones while the joint heals. Taping can also make walking more comfortable while you recover.
• Using inserts. Supportive orthotics can support your mid-foot joints and help prevent further injury. You can buy over-the-counter orthotics or have your doctor fit you for custom orthotics. Your doctor can give you a small foam cuboid wedge to wear with your shoes.
• Stretching. Your foot and ankle specialist will give you a set of stretching and strengthening exercises that can help restore your balance and your foot’s range of motion. Stretching can prevent stiffness and weakness in the mid-foot. Start practicing your exercises as soon as possible, and continue them through to your full recovery.