Cuboid Syndrome: symptoms and treatments

What is cuboid syndrome?

Several ligaments connect the cuboid bone to the heel bone. The cuboid bone is essential for many of our day-to-day activities, such as:

• Walking
• Helping your foot to flex
• Navigating uneven surfaces

Cuboid syndrome happens when the bone becomes partially dislocated from the calcaneocuboid joint—the joint between the calcaneus (heel) bone and the cuboid bone. This can happen gradually through overuse and repetitive strain, or it can dislocate suddenly during a foot or ankle injury. 

It’s important to remember that cuboid syndrome is different from a broken cuboid bone.

Causes of cuboid syndrome

There are three primary ways that a patient can develop cuboid syndrome:

Injury 

The same twisting motion that can lead to a sprained ankle is also a common cause of cuboid bone dislocation. Inversion ankle sprains—foot injuries where the ankle rolls outward and the foot rolls inward—are frequent causes of cuboid syndrome.

A common symptom of an inversion sprain and dislocation of the cuboid is a sharp, sudden pain in the outer mid-foot.

Less commonly, an eversion sprain—an injury caused by the ankle being forced inward—can also cause cuboid syndrome.

Overuse 

Ligaments and tendons hold your joints and bones together. The peroneus longus tendon forms a sling around the cuboid, so overuse or a sudden strain can tug the cuboid out of place.

Tension in the muscle can pull on the cuboid, causing dislocation over time. You may feel gradually worsening lateral foot pain (pain on the outside of the foot) as the injury progresses, or the pain may come and go.

Biomechanics 

Your feet are finely tuned mechanical devices designed to bear the weight of your body and keep you moving. This delicate balance of bones, joints, and soft tissues can be thrown off by any problems in the shape and form of your feet.

For cuboid injuries, over 80% of them occur in patients with flat feet. Flat feet can cause overpronation—an irregular walking gait where your feet roll inward as you walk or run—is a risk factor for cuboid syndrome because of the extra strain placed on the feet and ankles.

What are the symptoms of cuboid syndrome? 

Cuboid syndrome can often be mistaken for other types of foot pain, such as a stress fracture or peroneal tendonitis. Either due to misdiagnosis or attempting to ignore the pain in the hopes that it will resolve on its own, cuboid syndrome is commonly overlooked. However, the following symptoms can point to cuboid issues:

• Redness and swelling in the outer mid-foot
• The foot is tender to the touch
• Pain on the outside of the foot, which can travel to the lateral ankle or toes
• Pain that worsens with weight-bearing
• Pain that is worse first thing in the morning
• Pain when jumping, hopping, changing directions quickly, or walking on inclines
• Limping and difficulty walking
• Weakness when stepping off the ground

How do the podiatrists at University Foot & Ankle Institute diagnose cuboid syndrome? 

Cuboid syndrome is difficult to diagnose. The joint dislocation doesn’t always appear on basic imaging such as X-rays. However, the foot and ankle specialists at UFAI are experienced in a wide range of foot conditions. In most cases, advanced imaging such as our in-office MRI or CT scan will be used to rule out other possible causes of pain. They may press on the tender area while flexing your foot in different directions to assess what types of motion cause pain.

Almost 7% of ankle sprains are accompanied by a cuboid injury, often undiagnosed and untreated. If you have lingering pain two to three months after an ankle sprain, call University Foot and Ankle Institute’s podiatry clinic for an evaluation.

Will cuboid syndrome go away on its own?

While mild cases of cuboid syndrome might resolve independently through rest and self-care, it often does not heal on its own without intervention.

It's important for individuals experiencing symptoms of cuboid syndrome to consult with a foot and ankle specialist for an accurate diagnosis and appropriate treatment plan, as untreated cuboid syndrome can lead to chronic pain or long-term issues with foot function.

What are our cuboid syndrome treatment options? 

Unfortunately, you can’t typically treat cuboid syndrome at home. In most cases, we’ll use a technique called “manipulation” to move the joint back in place with a quick, forceful hand maneuver. Never try to do this on your own! After successful manipulation, you will likely experience immediate relief.

Sometimes, manipulation is not recommended, such as for patients with fractures, bone disease, gout, arthritis, nerve problems, or vascular problems. In severe cases, orthopedic surgery followed by visits to a physical therapist may be required.

After successful treatment of cuboid syndrome, you can also ease lingering symptoms and protect the foot from further injury by:

• Icing. Wrap a small bag of ice in a thin washcloth and place it over your mid-foot for 10-15 minutes, three times daily. Icing can help with pain and swelling.
• Resting. Keep weight off your foot for a few days after manipulation. You may use crutches to walk while your foot heals. Our doctors will let you know how long to wait before returning to physical activity.
• Taping. Wrap the inside of your foot, around the sole and over the top of the foot, with athletic tape to support the bones while the joint heals. Taping can also make walking more comfortable while you recover. · Shoe inserts. Supportive orthotics can support your mid-foot joints and help prevent further injury. Supportive inserts are available pre-made at most drug stores; UFAI also offers custom orthotics to support your unique feet.
• Stretching. Stretching and strengthening exercises can help restore your balance and your foot’s range of motion. Stretching can also prevent stiffness and weakness. Start practicing your exercises as soon as possible, and continue them to achieve a full recovery.
• Physical therapy. Going to physical therapy can help you strengthen the muscles and ligaments of your feet and ankles, protecting them from future injury.

Why is UFAI your best choice for treating cuboid syndrome? 

The University Foot and Ankle Institute physicians have decades of combined experience treating athletes of all levels, from the weekend warrior to the professional athlete and everything in between. Using the latest technologies available, many of which we helped develop, we can accurately diagnose and treat cuboid syndrome and the painful symptoms accompanying cuboid injuries.

University Foot & Ankle Institute is a nationally recognized expert in the treatment and correction of overuse injuries such as cuboid syndrome. Our podiatrists are at the forefront of treatment and research and are committed to offering state-of-the-art surgical and non-surgical foot and ankle treatments. We regularly teach our techniques to foot surgeons throughout the world

By offering a full spectrum of workup, conservative, surgical, and recovery options, we are truly taking care of you in a state-of-the-art manner without the need to go from place to place. To schedule a consultation, please call (855) 872-5249 or make an appointment now.

University Foot and Ankle Institute is conveniently located throughout Southern California and the Los Angeles area. Our foot doctors are available at locations in or near Santa Monica, Beverly Hills, West Los Angeles, Manhattan Beach, Northridge, Downtown Los Angeles, Westlake Village, Santa Barbara and Valencia.