Cuboid syndrome is somewhat uncommon and is poorly defined in the literature. When conditions are poorly defined in the literature, this usually means that there is a lack of agreement among doctors as to the eitiology (reason for the condition) and the treatment.

Treatment Of Cuboid Syndrome

Cuboid syndrome is treated by reducing (realigning) the subluxation of the CC joint and stabilizing the reduction. Reduction of the subluxation can be accomplished by manipulating the joint. Manipulation is performed with the patient in a prone (face down) position. The doctor cradles the foot in his/her hands and places both thumbs beneath the CC joint. The CC joint is then manipulated by a forceful movement, moving the leg at the knee and the ankle while applying pressure with the thumbs at the plantar (bottom) aspect of the CC joint.

Reduction of the subluxation can be maintained with taping, and padding. Prescription orthotics (arch supports) are helpful in preventing a recurrence of cuboid syndrome. Occasionally, cortisone injections may be helpful in reducing inflammation associated with the subluxation of the CC joint. Patients are instructed to avoid going barefoot or wearing shoes with low heels. Small (less that 1/2") heel lifts can also be helpful.

Chronic cuboid syndrome is called tarsitis (inflammation of the tarsal bones). Tarsitis results from excessive intrinsic load, often called CT band syndrome. Tarsitis is just one of many symptoms of CT band syndrome. For additional information regarding chronic cuboid syndrome (tarsitis), please read our article on CT band syndrome.

The response to treatment of cuboid syndrome depends upon the eitiology and onset of symptoms. Acute onset of cuboid syndrome, say from an ankle sprain, may respond dramatically to manipulation. If cuboid syndrome is due to chronic, excessive intrinsic load (CT band syndrome) treatment such as manipulation may be less effective and take longer to see results.

Nomenclature:

Cuboid - named after its' square shape. The cuboid has historically been used in games as a dice.

Chopart's Joint - includes the talo-navicular joint and the calcaneal-cuboid joint. Named after the French surgeon Francois Chopart (1743-1795).

CT band - 'calf to toes' band. Describes a band consisting of the calf, Achilles tendon, ankle and plantar fascia.

Extrinsic load - any load delivered to the foot that is exclusive of intrinsic load. Extrinsic load includes the duration of time on your fee, number of steps taken in a day, body weight, etc.

Intrinsic load - load that is intrinsic to the normal mechanical function of the leg and foot. Most intrinsic load is derived from the calf and delivered to the foot via the Achilles tendon. Other sources of intrinsic load include the other plantar flexor muscles and tendons of the foot such as the peroneals and posterior tibialis.

Subluxation - motion of a joint that is irregular and not in alignment with the normal range of motion of the joint.

Tarsal bone - the large bones of the rear foot including the calcaneus, talus, navicular and cuboid.

Anatomy:

The calcaneal-cuboid joint (CC joint) is located on the lateral (outside) aspect of the foot. The CC joint can be found immediately below the outside of the ankle and about two fingers distal (towards the toes). The CC joint is a broad, flat joint build to bear

The CC joint is also stabilized by a number of contiguous structures that pass above, below or along the cuboid. The most significant of these is the peroneus longus tendon that wraps along the lateral and plantar aspects of the cuboid. The cuboid is essentially help in a sling by the peroneus longus tendon. Other structures include the peroneus brevis tendon, dorsal and plantar musculature and retinaculum.

Biomechanics:

Cuboid syndrome occurs at the calcaneal-cuboid joint (CC joint) on the lateral or outside of the foot. The CC joint functions together with the talo-navicular joint (TN joint) and the subtalar joint (STJ) to deliver load to the forefoot. The function of these joints is to deliver load that can be converted into action; walking, running etc. For additional definitions of load in relationship to the normal function of the foot and leg, please refer to our article on CT band syndrome.

Cuboid syndrome occurs when the calcaneal-cuboid joint is unable to carry the load that is applied to it. The result is that the calcaneal-cuboid joint subluxes (moves out of its' normal position).

Symptoms:

The onset of cuboid syndrome may be due to an acute injury of the lower extremity such as an inversion sprain of the ankle. Occasionally the symptoms of cuboid syndrome occur without an obvious injury. The symptoms of cuboid syndrome are very similar to the symptoms of a sprain. Pain is significant when weight is first applied to the foot. Pain increases with the toe off phase of gait as the weight of the body and load from the calf muscle are delivered to the lateral (outside) column of the foot.

Cuboid syndrome rarely presents with bruising or swelling. The location of cuboid syndrome (at the calcaneal cuboid joint) can be pin pointed by this simple method; visualize a line extending from the outside ankle bone (fibula) to the floor. The calcaneal cuboid joint is approximately two fingers from this line distal (towards the toes).

Differential Diagnosis:

Calcaneal stress fracture

Sinus tarsi syndrome

Peroneal tendonitis

Partial peroneal tendon rupture

5th metatarsal avulsion fracture

Compression neuropathy of the sural nerve

Cuboid fracture

Os peroneum

Gout

Tarsal coalition

Tarsitis

References:

1. Stone DA, Kamenski R, Shaw J, Nachazel KMJ, Conti SF, Fu FH. Sports Injuries, Mechanics, Prevention, Treatment-Second Edition. Philadelphia, Lippincott Williams and Wilkin; 2001. pp381-397.

2. Leerar, PJ. Differential Diagnosis of Tarsal Coalition versus Cuboid Syndrome In An Adolescent Athlete. J Orthop Sports Phys Ther 2001; 31(12)

3. Marshall P, Hamilton WG. Cuboid Subluxation In Ballet Dancers. Am J Sport Med 1992; 20(2).

4. Mooney M, Maffey-Ward L. Cuboid Plantar And Dorsal Subluxations: Assesment And Treatment. J Ortho Sports Phys Ther 1994; 20(4).
About the Author

Jeffrey A. Oster, DPM, C.Ped is a board certified foot and ankle surgeon. Dr. Oster is also board certified in pedorthics. Dr. Oster is medical director of Myfootshop.com and is in active practice in Granville, Ohio.