What is Cuboid Syndrome?

Cuboid syndrome is a cause of pain on the outside of the foot, that is if it actually exists. There is some controversy as to what it exactly is with some doubting it exists and the cause of the symptoms is due to a range of other types of problems. There is not a lot of evidence on this, but there are lots of opinions.

Traditionally, in cuboid syndrome, the cuboid is assumed to become partially subluxed due to excessive traction from peroneus longus tendon if the foot is excessively pronated. Because of this the cuboid is not stable as peroneus longus muscle contracts and the lateral aspect of cuboid is pulled dorsally. This subluxation is thought to be what cuboid syndrome is. The cuboid may also become subluxed after a lateral ankle sprain. Pain in the outside of the foot is thought to occur in about 4% of all foot injuries in athletes.

Clinically, in a cuboid syndrome there is lateral foot pain on weightbearing over cuboid area and there can be a generalised foot discomfort, especially over that lateral aspect of foot. Pressing the cuboid bone upwards can produce pain and that bone may feel restricted in movement when compared to the unaffected foot. There is no evidence that this subluxation can be seen on x-ray, which is partly why so many doubt that this syndrome actually exists. This doubt is also based on the very strong ligament structure around this bone and how could it possibly sublux if the bone is so firmly held in place.

There is no doubt that there is this pain on the outside of the foot that does have many characteristics in common, its just can they all be contributed to the entity that commonly gets called cuboid syndrome. The differential diagnosis for pain in this area is a long list, so the pain could be due to anyone of them and not just the cuboid syndrome as it has been described. This list includes stress fractures, a peroneal tendonitis, irritation of the sesamoid bone and many others. Pain in this area is also common following a plantar fascia surgical release for those with chronic plantar fasciitis. A number of these conditions that can also cause pain in this area will also get better to the treatments that are typically used to treat cuboid syndrome.

The traditional approach to the treatment of cuboid syndrome is to modify activity so pain levels are kept tolerable. If the pain is particularly bad, then ice can be used or perhaps pain relief medication such as NSAID’s. Strapping is also often used to stabilise the area. Foot orthotics with what is called cuboid notch to support the area are also commonly used. There is a manipulation to push the cuboid upward and laterally from the plantar surface that is often done which does often give dramatic results, which is why this is assumed by so many to be a subluxed cuboid. The reason for the manipulation working so well is not clear.