As a physical therapist, sometimes the best way to learn about a condition is to experience it yourself. I had a first hand experience of the pain and difficulty caused by cuboid syndrome. I was not even a half mile into my run when I had a very sharp pain on the outside of my foot. It was so painful that I had to stop running and was limping while walking. I figured out that my cuboid was out of place fairly quickly simply because of the experience and knowledge from my job. I also know that I have a risk factor of hypermobile feet. Just as I was getting ready to sit down, take my shoe off and try to shift the bone back into position, I felt it pop back in. I then went on to finish my run. Ready to learn more about cuboid syndrome? Let’s start with anatomy.
What is the cuboid?
The cuboid is a bone located on the outside middle of the foot. It articulates or connects to 5 other bones of the foot including the calcaneous. The calcaneocuboid joint is a relatively stable joint. It does not move much but does shift to a small degree during foot movements. These small shifts allow for normal foot mobility.
What is cuboid syndrome?
Cuboid syndrome is caused by a disruption of the normal movement of the calcaneocuboid joint. Very forceful movements could cause the cuboid to shift out of position which interrupts the normal mechanics of the joint. Holding a position too long might cause the calcaneocuboid joint to get stuck in place. As mentioned prior, this joint does not move much but does play a vital role in foot mobility. So if it does not move or moves improperly, it is very noticeable and can cause significant pain on the outside of the foot. The pain tends to occur suddenly and increases when trying to stand or walk on the foot.
What causes cuboid syndrome?
Cuboid syndrome is not well understood and goes by many different names which include cuboid fault syndrome, subluxed cuboid, and locked cuboid. Even though it is not well understood, it occurs relatively often. It represents 4% of all foot injuries in athletes. It is unknown what actually causes cuboid syndrome. However there are several proposed mechanisms of injury.
- Inversion ankle sprain
- This is also known as a lateral ankle sprain and is the most common type of ankle sprain.
- Inversion ankle sprains occur when the ligaments on the outside of the ankle are stretched or torn when the foot is pointed and rolled inward excessively.
- 7% of those with inversion ankle sprains will develop cuboid syndrome.
- Overuse
- Repeated microtrauma from high intensity sports or activities could cause a disruption in the calcaneocuboid joint.
- Cuboid syndrome is common in athletes.
- Approximately 17% of ballet dancers have had cuboid syndrome.
- Over pronation
- This mean that the foot rolls inward when walking. The arch of the foot might decrease or disappear when standing or walking on the foot.
- A high percentage (up to 80%) of those with excessive pronation have cuboid syndrome at some point.
What are the symptoms of cuboid syndrome?
There are several symptoms associated with cuboid syndrome. These include:
- Sharp pain on the outside of the foot
- Could also have pain on the bottom of the foot.
- Pain tends to happen suddenly
- Swelling on the outside of the foot
- Pain when putting weight on the foot – walking or standing on the foot
- Difficulty walking
- Pain goes away taking weight off of the foot – sitting or lying down
Are there risk factors for cuboid syndrome?
There are several risk factors associated with cuboid syndrome. These include:
- Hypermobility or instability of the foot
- Overweight or obese
- Shoes or orthotics that don’t fit or have little support
- Previous ankle sprain
- Intense activity, sport, or exercise
- Inadequate exercise recovery
- Training on uneven surfaces
- Excessive pronation
Who should I see?
- Physical therapy – This would be my first stop. Physical therapy is usually all that is needed in the case of cuboid syndrome. Your PT will use manipulation and manual therapy techniques to shift the cuboid back in the correct position and get the calcaneocuboid joint moving again. PT can also evaluate and address abnormal joint mobility, muscle weakness, and flexibility. Your gait, shoe wear, training schedule, and technique will be assessed to prevent the problem from happening again.
- Orthopedic physician – An orthopedist might be necessary if the condition is not responding to physical therapy. Your orthopedist can order imagining to help determine the cause of the foot pain.
What can I do at home?
- Relative rest – Resting the area to decrease pain and swelling is one of the best ways to treat cuboid syndrome. This might include changing up your training schedule and cross training with other activities to decrease the stress on the foot. Swimming and biking would be good alternative activities that do not put much stress through the ankle and foot.
- Ice – Ice can help decrease the pain and swelling at the tendon.Ice the painful area for 15 to 20 minutes at a time. I would recommend using an ice pack several times per day if the pain is constant or preventing you from participating in an activity. Ice immediately after activity.
- Stretching – Stretching the calf muscles can help improve the motion at the ankle. This includes stretching the gastrocnemius and the soleus. See the video below.
- Strengthening – It is important to strengthen the tibialis posterior, calf muscles, and the muscles of the knee, and hip. All of these muscles work together to stabilize the ankle and foot while running, cutting, and jumping. Using loop resistance bands , resistance bands and ankle weights can increase strength and difficulty of the exercises. See the videos below.
- Balance – Working on balance is important in strengthening the foot and ankle but also improving proprioception. Improving proprioception will help improve the overall stability of the ankle. See the video below.
- Shoe wear and orthotics – Having flat feet is a huge risk factor for cuboid syndrome. Changing shoe wear or using orthotics to place the foot in a neutral position will help decrease the stress on the tendon. An overpronation shoe might help or you might need orthotics. Most running stores will evaluate your foot type and suggest appropriate shoe wear and/or orthotics. Your PT can also evaluate your foot and help determine appropriate shoe wear.
- Bracing – Using a stability brace or ankle sleeve can be helpful to decrease pain and improve stabilization at the ankle. This is especially useful for those that have chronic ankle instability or who have suffered from previous ankle injuries.
- Compression socks – Compression socks can help decrease swelling and pain by improving circulation while running and walking.
In review
- The cuboid is a bone located on the outside of the middle of the foot.
- Cuboid syndrome is caused by a disruption of the normal movement of the calcaneocuboid joint.
- Cuboid syndrome is not well understood but has several proposed causes.
- Inversion ankle sprain
- Overuse
- Over pronation
- Symptoms include a sudden sharp pain on the outside of the foot with weight bearing.
- The biggest risk factor is over pronating.
- Physical therapy is usually all that is needed in the case of cuboid syndrome.
- An orthopedist might be necessary if the condition is not responding to physical therapy.
- There are several things you can do at home.
- Relative rest
- Ice
- Stretching
- Strengthening
- Balance
- Shoe wear
- Bracing
- Compression socks
As always, If you have questions about the content of this post or any other musculoskeletal questions, please e-mail me.
Additional resources
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3445231/
https://www.choosept.com/guide/physical-therapy-guide-cuboid-syndrome