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Cuboid Bone Pain: Causes, Symptoms, Diagnosis & Treatment of Cuboid Syndrome

Cuboid syndrome is a condition that results when the cuboid bone in the foot becomes dislocated or misaligned. This can lead to pain, swelling in the foot, and difficulty walking.

Cuboid syndrome is often caused by injuries, such as a fall or direct blow to the foot. However, it can also be caused by wearing shoes that do not fit correctly or overuse.

Diagnosing cuboid syndrome can be challenging due to the complexities of foot anatomy and overlapping symptoms with other conditions, such as stress fractures and ankle sprains.

What is Cuboid Syndrome?

Cuboid syndrome is a medical condition that affects the cuboid bone, one of the seven tarsal bones in the foot. This condition is characterized by pain and inflammation on the lateral side of the foot, often resulting from various factors such as overuse, ankle sprains, and altered foot biomechanics.

The cuboid bone plays a crucial role in the stability and function of the foot, acting as a keystone for the lateral arch. When the cuboid bone becomes injured or displaced, it can lead to cuboid syndrome, causing significant discomfort and impairing mobility. Understanding this condition’s underlying causes and mechanics is essential for effective

Why is the Cuboid Bone important?

The Cuboid is essential for two main reasons:

  1. It helps to stabilize the arch of the foot.
  2. It provides a point of attachment for several muscles and ligaments that help to move the foot and ankle.

The navicular and cuboid bones work in tandem during gait, highlighting the importance of joint mechanics, stability, and the role of ligaments and tendons in facilitating movement and load transfer in the midfoot.

Cuboid Syndrome

Lateral foot pain

“Cuboid syndrome is an underappreciated cause of lateral midfoot pain.

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Lateral plantar neuritis is another condition associated with lateral midfoot pathology and can often be misdiagnosed, emphasizing the need for careful assessment of symptoms.

The most common symptom of cuboid syndrome is pain on the outside of the foot. This pain is usually worse when walking or running and may become severe enough to limit your ability to participate in activities.

The pain is often caused by the dislocation or misalignment of the cuboid bone. This can lead to inflammation and swelling in the foot. You may also feel a popping or clicking sensation when the Cuboid moves out of place.

Cuboid Bone: Anatomy and mechanics

Cuboid bone is part of the midfoot

The Cuboid bone is one of the five bones that make up the midfoot section of the foot. The Cuboid is located on the lateral, or outside, aspect of the foot behind the fourth and fifth metatarsals (long bones in the foot).

The Cuboid plays an important role in stabilization and balance. It also helps to transmit weight from the metatarsals to the heel bone (calcaneus).

The cuboid squeeze technique involves gradually stretching the ankle and toes into maximal flexion before applying a squeezing pressure to the cuboid bone to alleviate pain and improve alignment.

Which muscles affect the cuboid bone?

The muscles that interact with the Cuboid are:

  • Peroneus Longus muscle (Fibularis Longus) and Peroneus Brevis Muscle (Fibularis Brevis), which evert (outward rotation) the foot at the ankle.
  • Tibialis posterior, which inverts (inward rotation) the foot at the ankle
  • Flexor Digitorum Longus and Brevis, which flex the toes.

These muscles help to stabilize the foot and allow for proper balance when walking or standing. Cuboid syndrome can occur when these muscles become weak or tight, resulting in the Cuboid becoming dislocated or misaligned.

Which tendons are important to the cuboid bone?

Ligaments and tendons of the foot and ankle

Two tendons also stabilize the Cuboid:

  • The Peroneus Longus Tendon attaches the Peroneus Longus muscle to the Cuboid, while the
  • The Peroneus Brevis Tendon attaches the Peroneus Brevis muscle to the Cuboid.

Which ligaments are important to the cuboid bone?

Three main ligaments connect the Cuboid to the other bones in the foot. These ligaments help to stabilize the Cuboid and prevent it from becoming dislocated or misaligned.

  • The Lateral collateral ligament (LCL) connects the Cuboid to the Fibula (the smaller of the two bones in the lower leg).
  • The Anterior and Posterior Tibiofibular ligaments connect the Cuboid to the Tibia (the larger of the two bones in the lower leg).
  • The Cuboideonavicular ligament (CBD) connects the Cuboid to the Navicular bone (located in the midfoot).

What are the symptoms of cuboid Syndrome?

Pain on the outside of the foot is the most frequent symptom of cuboid syndrome. This pain is usually worse when you walk or stand on your feet for long periods. Other symptoms may include:

  • Swelling: cuboid syndrome often causes swelling on the outside of the foot.
  • Bruising: The foot may also bruise easily due to the misaligned cuboid bone.
  • Tenderness: You may feel tenderness when you touch the affected area.
  • Redness: The skin around the cuboid bone may look red and irritated.
  • Stiffness: The Cuboid may feel stiff and difficult to move.
  • Difficulty walking: cuboid syndrome can make it difficult to walk or even stand on your feet for long periods.

Pronated or Flat Feet

One common cause of cuboid syndrome is overpronation or flat feet. When you pronate, your foot rolls inward too much when you walk. This change in position can put too much pressure on the cuboid bone and cause it to become dislocated or misaligned.

Overpronation can be caused by several factors, including genetics, injury, or even the type of shoes you wear. For example, people with flat feet or high arches are more likely to pronate due to altered foot biomechanics.

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What else can cause Cuboid syndrome?

Other causes of cuboid syndrome include:

  • Ankle sprain: A sprained ankle can cause the cuboid bone to dislocate or misalign.
  • Arthritis: Arthritis of the foot can damage the ligaments that support the cuboid bone and lead again to its dislocation or misalignment.
  • Direct blow: A direct blow to the foot, such as from a fall or car accident, can cause the cuboid bone to become dislocated or misaligned.
  • Overuse: Repeated stress on the foot, such as from running or jumping, can lead to the cuboid bone becoming dislocated or misaligned.
  • Landing on foot after a jump can also cause the cuboid bone to dislocate or misalign.
  • Shoes that don’t fit properly: Wearing shoes that are too tight or loose can also lead to Cuboid syndrome. Shoes that are too tight can put pressure on the Cuboid and cause it to become dislocated or misaligned. Shoes that are too loose can cause your foot to pronate, which can also lead to Cuboid syndrome.

Manipulation techniques should be avoided in patients with conditions like bone disease, inflammatory arthritis, or fractures, as these ailments can complicate the treatment approach.

What is an inversion ankle sprain?

Inversion ankle sprain can impact the health of the cuboid bone and the midfoot

Inversion ankle sprains occur when the foot rolls inward, causing the ligaments on the outside of the ankle to stretch or tear. This type of injury can also lead to cuboid syndrome. The cuboid squeeze technique may not be suitable for patients with a coincident lateral ankle sprain, as this technique requires the ankle to be maximally plantar flexed, which could aggravate the sprain before the ankle has sufficiently healed.

Inversion ankle sprains are one of the most common types of ankle injuries. They often occur during sports or other physical activities.

Athletes and cuboid syndrome

Cuboid syndrome is common in athletes, especially those participating in jumping or running sports. This is often because the cuboid bone and surrounding structures are under a lot of stress when you are active.

Athletes may also be more likely to suffer from cuboid syndrome if they have pronated feet or low arch feet. The altered foot mechanics can put extra stress on the cuboid bone.

How do you diagnose cuboid Syndrome?

Cuboid syndrome is often diagnosed based on your symptoms and a physical exam. 

They will check for tenderness, swelling, and bruising during the exam. 

Your doctor, podiatrist, or other recognized health care provider may also order X-rays or an MRI (magnetic resonance imaging) to confirm the diagnosis.

How can Cuboid Syndrome be misdiagnosed?

Cuboid syndrome is often misdiagnosed as a sprained ankle. This is because symptoms, such as pain and swelling, are similar to those of a sprained ankle. Cuboid syndrome may also be misdiagnosed as a lateral ankle sprain, especially if persistent pain is present even after lateral ankle symptoms subside.

Cuboid syndrome is also sometimes misdiagnosed as tendonitis. Tendonitis is an inflammation of the tendons, which are the tissues that connect muscles to bones.

The symptoms of cuboid syndrome and tendonitis can be similar. Still, tendonitis usually affects the tendons in the foot, not the cuboid bone.

It is essential to see a doctor if you are experiencing any of the symptoms of cuboid syndrome so that you can receive an accurate diagnosis and treatment.

What other foot injuries include the cuboid bone?

Several common foot injuries can involve the cuboid bone, including:

Cuboid fracture

  • A cuboid fracture is a break in the cuboid bone. 
  • This can be caused by a fall or direct blow to the lateral foot. 
  • Symptoms of a cuboid fracture include pain, swelling, and bruising.

Cuboid subluxation

  • A subluxated cuboid is when the cuboid bone becomes partially dislocated. 
  • This can be caused by overuse or repetitive stress on the foot. 
  • Symptoms of cuboid subluxation include pain, tenderness, and swelling.

Cuboid dislocation

  • Cuboid dislocation is when the cuboid bone becomes completely dislocated. 
  • This can be caused by a fall or a direct blow to the foot. 
  • Symptoms of cuboid dislocation include pain, tenderness, swelling, and bruising.

Cuboid fractures, subluxations, and dislocations are all serious injuries that can cause lasting damage to the foot. Suppose you have any of these injuries. In that case, it is essential to see a doctor or other recognized healthcare provider immediately.

Cuboids' effect on posture

Flat feet can cause problems for the cuboid bone

Cuboid Syndrome can also affect your posture. When the cuboid bone is misaligned, it tends to move the rest of the bones in your foot. Pain and difficulties walking or standing are possible outcomes.

Poor foot mechanics can lead to alterations further up the body (or formally along the kinetic chain) and cause the knee, hip, and back to be misaligned.

How to treat cuboid syndrome

Rest: Cuboid syndrome often improves with rest. You may need to stay off your feet for a few days or weeks to allow the d bone to heal.

Ice: Applying ice to the affected area can help reduce pain and inflammation.

Compression: Wearing a compression bandage can also help reduce swelling.

Elevation: Keeping your foot elevated above the level of your heart can help reduce swelling.

Pain relief: Over-the-counter pain medications, such as ibuprofen, can help relieve pain.

Stretching and strengthening exercises: Exercising to stretch and strengthen the muscles and ligaments around the cuboid bone can help prevent Cuboid syndrome from recurring.

Cuboid taping: Cuboid taping is a type of tape applied to the foot to help support the cuboid bone.

Ankle or foot brace: Wearing an ankle or foot brace can help support the d bone and reduce pain.

Orthotics: Orthotics are devices worn in the shoe to help support the foot. They can be custom-made or over-the-counter.

Cuboid manipulation: Cuboid manipulation is a treatment that involves manually moving the cuboid bone into its proper position. This is usually done by a chiropractor, osteopath, physical therapist, or other trained health care provider.

Surgery: In some cases, surgery may be necessary to realign the cuboid bone.

Recovery and Outlook

The recovery time for cuboid syndrome can vary depending on the severity of the condition and the effectiveness of the treatment plan. Generally, most individuals begin to feel relief within a few days of initiating treatment, but complete healing can take several weeks.

Podiatry or Physical therapy is often a key component of recovery, as it helps to strengthen the muscles and ligaments around the cuboid bone, promoting full recovery and preventing future injuries.

Additionally, a doctor or therapist may recommend using an ankle or foot brace to provide extra support and stability for the foot and ankle during the healing process.

With proper treatment and care, most people can make a full recovery from cuboid syndrome and return to their normal activities without long-term complications.

Prevention

Preventing cuboid syndrome requires a combination of proper foot care, exercise, and appropriate footwear. Here are some tips to help avoid cuboid syndrome:

  • Wear Proper Fitting Shoes: Ensure your shoes provide adequate support and cushioning for the foot. Ill-fitting shoes can lead to altered foot biomechanics, increasing the risk of cuboid syndrome.
  • Engage in Regular Exercise: Strengthening the muscles and ligaments in the foot and ankle can help maintain stability and prevent injuries.
  • Avoid Overuse: Be mindful of repetitive stress on the foot and ankle. Incorporate rest periods into your routine to allow your feet to recover.
  • Use Orthotics: Orthotics or shoe inserts can help correct biomechanical issues that may contribute to cuboid syndrome. Custom-made orthotics are particularly effective.
  • Stretch Regularly: Regular stretching can improve flexibility and reduce the risk of injury. Focus on stretches that target the foot and ankle.
  • Avoid High-Risk Activities: If you have a history of cuboid syndrome, consider avoiding activities that involve repetitive jumping or landing, such as basketball or tennis.

By following these tips, you can reduce your risk of developing cuboid syndrome and maintain healthy, functional feet. Taking proactive steps in foot care and being mindful of your activities can go a long way in preventing this painful condition.

Finally

Cuboid Syndrome is a condition that can cause pain and difficulty walking. Therefore, it is essential to see a doctor or other recognized health care provider if you think you may have Cuboid Syndrome to receive an accurate diagnosis and treatment.

PLEASE NOTE

PostureGeek.com does not provide medical advice. This information is for educational purposes only and is not intended to be a substitute for professional medical attention. The information provided should not replace the advice and expertise of an accredited health care provider. Any inquiry into your care and any potential impact on your health and wellbeing should be directed to your health care provider. All information is for educational purposes only and is not intended to be a substitute for professional medical care or treatment.

About the author

Nicholas Barbousas is the founder of PostureGeek.com and an experienced therapist with extensive expertise in human movement and physical conditioning. With over 30 years in the profession, he specializes in Rolfing Structural Integration, utilizing proven methods to enhance body alignment and functional health. As an educator and author, Nick has developed comprehensive programs in manual therapy, myofascial release, and fitness training, advancing the practice of manual and movement therapies through his contributions to PostureGeek.com.

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