Foot pain can be an inconvenience and confusing at times as it will develop seemingly out of no-where. One day you are fine the next you take a step out of bad and seem to hit the roof as quickly as you hit the floor. For those who have pain on the outside (lateral) of their foot it can be even more frustrating as it very rarely lines up with what they expect for someone with a “flat feet”.

The cuboid bone is a lateral tarsal bone which is supported in part by the peroneal tendons. Cuboid Syndrome is a painful injury effecting the proximal aspect of the lateral mid-foot. It can be both acute or chronic in nature and common in those with hypermobile joints and recurrent lateral ankle sprains. A number of mechanisms of injury are possible including; direct trauma, poor rehabilitation, movement patterns and ankle sprains.
Cuboid Syndrome can be missed at times to the vague presentations and confusing pain patterns. Pain can present at the plantar, dorsal and lateral aspects of the midfoot at times and only at one of those aspect at others. This can lead to misinterpretation of symptoms by the clinician and the patient all the same and continue lead to referral of medical imaging – which will commonly come up with little to no conclusion, dependant on severity.

The incidence is believed to be rare or under reported. It is most common in ballet dancers as the result of an inversion sprain where the foot is in a plantarflexed at ground contact leading to a reflex contraction of the peroneal tendon as the foot looks to pronate for shock attenuation on landing (Adams & Madden, 2009).

Management of the condition requires mobilisation and adjustment of the joint if deemed necessary by the practitioner, however, in many cases this is not required and simple off-loading techniques and a rehabilitative strengthening program is required.
The rehabilitative program should include activation, control and strengthening of the extrinsic muscle which cross into the foot from the lower leg as well as intrinsic muscle strengthening. Additionally, proprioceptive exercises should be complete by the patient to increase ankle joint stability.
The exercises should be continued until the patient reaches pre-injury ability and in many cases should be taken beyond that point for best outcomes.

In conclusion, it doesn’t matter if you have a flat or high arched foot when it comes to cuboid syndrome. The most common cause is associated with previous injury or chronic ankle instability leading to an overload of tissues and a sub-laxation of the cuboid from its original position. 

Until Next Time

Jackson McCosker
Director/ Chief Editor

References

Adams, E., & Madden, C. (2009). Cuboid Sublaxation: A Case Study and Review of the Literature. Current Sports Reports, 300 – 307.

Borrelli, J., De, S., & VanPelt, M. (2012). Fracture of the Cuboid. Journal of the American Academy of Orthopedic Surgery, 472 – 477.

Gallagher, S., Rodriguez, N., Anderson, C., Granberry, W., & Panchbhavi, V. (2013). Anatomic Predisposition to Ligamentous Lisfranc Injury: A MAtched Case- Control Study. The Journal of Bone and Joint Surgery, 2043 – 2047.

Moraleda, L., Salcedo, M., Bastrom, T., Wenger, D., Albinana, J., & Mubarak, S. (2012). Comparison of the Calcaneo-Cuboid-Cuneiform Osteotomies and Calcaneal Lengthening Osteotomy in the Surgical Treatment of Symptomatic Flexible Flatfoot. Journal of pediatric and Orthopaedics, 821 – 829.

Sanudi, J., & Vazquez, T. (2014). The Peroneocubiod Joint: Morphogenesis and Anatomical Study. Journal of Anatomy.

Senaran, H., Mason, D., & De Pellegri, M. (2006). Cuboid Fractures in Preschool Children. Journal of Pediatrics and Orthopedics , 741 – 744.