Last week I saw a patient whom I suspect has this condition, and an x-ray was requested; will see how it goes when the results are in. This condition, also known as a subluxed cuboid, is a disruption of the cuboid bone, which lies on the outside of the foot, in its alignment with the adjacent bones. The disruption of this bone, causes irritation to the surrounding soft tissue structures that attach to it.

This is a condition seen more often in athletes, due to the excessive pressure and motion that that their feet are put through. It is thought, that the most common cause of a subluxed cuboid, is due to excessive inversion of the ankle, or excessive plantarflexion of the foot. Certain athletes are seen at being at greater risk of developing this syndrome. Ballet dancers are also very prone to this injury, due to repetitive jumps. Some dancers are prone to a subluxed cuboid, as a result of the second most cause of this condition, overuse injuries.  It’s where there is a repetitive microtrauma to the ligaments attaching to the cuboid bone.

What does cuboid syndrome feel like?

Symptoms

• Pain that develops rapidly after an inversion sprain.
• In some instances it develops gradually, after a prolonged period of time, following an inversion sprain.
• Pain is usually directly over the cuboid bone.
• Pain may also travel underneath the foot, into the arch.
• Surrounding structures may also be painful.
• Pain may be present when weight bearing and non-weight bearing, but it certainly becomes more difficult to walk.
• The lateral side of the foot will exhibit swelling; may be black and blue; and there may also be some redness; all signs of inflammation.

What causes it?

Factors that can cause cuboid syndrome include:

• running on uneven surfaces, streets where the foot is forced into supination.
• excessive weight; like most foot problems, too much body weight puts extra strain on the feet and ankles.
• worn out athletic shoes, which do not adequately support the foot, can aggravate this problem.
• feet that exhibit too much motion at the level of the subtalar joint, and creates excessive inversion or eversion.

Diagnosis

The diagnosis cannot be made by use of x-ray or MRI, because the subluxation is so minor, that imaging studies would be of little value. However, at least an x-ray is indicated to rule out other pathology, especially  fractures. A CT scan can be done to investigate the possibility of a fracture of the cuboid, as it seems to better outline the cortex (outer layer of bone), than an MRI or x-ray. Quite often, this condition may be confused with peroneal tendonitis, and fifth metatarsal base fractures.

Treatment

Conservative Treatment

The primary treatment is manipulation of the cuboid bone back into place. In many instances relief from pain is immediate. Other forms of treatment include:

• physical therapy
• taping the foot in a certain manner to force the cuboid back into position. This can be accomplished through low-dye strapping or KT taping.
• an orthotic with a built-in cuboid pad, can be very helpful in maintaining the position of the cuboid

Cuboid Fracture

In cases of simple non-displaced fractures, where there is essentially a crack in the bone, but no separation of the two ends of the bone, initial treatment consists of immobilisation with non-weightbearing.

This approach is recommended, because when bearing weight, the pressure exerted on the outside of the foot, even in a cast, can be enough to affect the healing process. A bone stimulator may also be used to aid in healing.

Surgical Treatment

Where immobilisation does not remedy the situation, surgery may be indicated. For simple cuboid fractures, in many instances a bone fusion is performed between the calcaneus (the bone behind the cuboid), and the cuboid bone itself. This fusion creates better stabilisation of the cuboid bone, thus reducing pain. If the fracture is from trauma, the bone itself may require insertion of hardware to stabilise it, as well as fusion to the calcaneus.

                          Your feet mirror your general health . . . cherish them!