Foot Pain: Cuboid Syndrome

cuboid syndrome

Cuboid Bone

Cuboid syndrome is a medical condition caused when the cuboid bone moves out of alignment. It is most often the result of injury or trauma to the joint and/or ligaments surrounding the small tarsal bone. Cuboid syndrome causes discomfort and pain on the outside (lateral side) of the foot. The pain is most often felt around the center of the foot favoring the side where the pinky toe (fifth toe) is located. It has also been reported close to the base of the fourth and fifth toes.

Patients sometimes report difficulty in identifying the exact location of the pain. This can make diagnosing cuboid syndrome a challenge. It can sometimes be misdiagnosed as a stress fracture, even though stress fractures in the cuboid bone are rare.

In this post, I will present you with information about cuboid syndrome, including the causes, symptoms, diagnosis, and treatment options.

Cuboid Syndrome: What is it?

The cuboid bone is one of seven small tarsal bones in the foot. It is found on the lateral (or little toe) side of the foot. Cuboid syndrome results when the cuboid bone moves out of proper alignment causing stress on the surrounding tissue and ligaments. Cuboid syndrome (also called subluxation of the midtarsal joint) occurs when the cuboid bone falls out of alignment with the adjacent bone; the calcaneus bone.

This partial dislocation of the bones in the joint can result from an abrupt injury or excess wear and tear on the joints in the middle of the foot.

Cuboid Syndrome: How Common is it?

Studies show that while cuboid syndrome is not uncommon within the general population, it occurs more frequently among athletes and dancers. A study released in 2011 found that about 4% of those athletes who suffer from foot injuries experienced problems with the cuboid area.

When properly identified and treated in a timely manner, most individuals with cuboid syndrome make a full recovery.

Cuboid Syndrome: What are the Risk Factors?

Cuboid Syndrome causesIndividuals who demand a lot of their feet (for example, athletes and dancers) may be at highest risk for developing cuboid syndrome. High impact activities along with repetitive motions can lead to cuboid syndrome.

Additionally, individuals who are significantly overweight may be at higher risk to develop problems with their cuboid as a consequence of the extra stress placed on the structures of the foot.

Cuboid Syndrome: What are Some Common Symptoms?

Typically, cuboid syndrome first presents as discomfort or pain on the lateral (outer) side of the foot. Some sufferers report a sudden onset of pain while for others it develops slowly over time. There are some tell-tale signs that can help you and your physician identify the cause of the pain.

Pain associated with cuboid syndrome typically exhibits the following characteristics: 

  • pain focused on the lateral (little toe side) of the foot,
  • discomfort increases when weight is placed on the foot,
  • pain can be either sharp and acute, or dull and aching, 
  • you will likely have difficulty walking,
  • hopping or jumping is very challenging,
  • you may experience swelling,
  • pain can increase when standing on your toes,
  • your foot and/or ankle may suffer from a reduced range of motion,
  • the bottom of your foot may become sensitive and
  • pain may radiate to the outside of the ankle.

If you are suffering from any of these symptoms, it is time to pay a visit to your doctor.

Cuboid Syndrome: Diagnosing the Problem

Cuboid Syndrome diagnosisWhile pain is the most common symptom, there are other signs and tools that healthcare providers can use to diagnose cuboid syndrome. The pain that accompanies cuboid syndrome is almost as bad as that associated with a fracture.

Patients with cuboid syndrome will definitely have significant pain, almost as if there is a fracture in the foot. Most sufferers develop an antalgic gait (limp) to compensate for the pain. Not all cases of cuboid syndrome are preceded by a major trauma nor is it always accompanied by swelling and/or bruising. This can lead many people to ignore the pain assuming that it will get better on its own.

Even when an x-ray is taken, the results are generally negative.

The slight rotation inducing cuboid syndrome is difficult to detect. The technician may, however, be able to makeout a small gap at the joint between the calcaneus and cuboid bones on a lateral x-ray. Adding to the difficulty, there are natural variations of the size of the gap throughout the population.

Patients will report tenderness when pressure is placed on the cuboid during a physical examination. Your doctor will rotate and move your foot to get an idea of your range of motion and when the pain is greatest. Your doctor may ask you to push against his or her hand or raise your toes one by one.

Cuboid Syndrome: Causes

Cuboid syndrome may be caused by the following:

Overuse: One of the most common causes of cuboid syndrome is overuse. For this reason, cuboid syndrome seems to occur most frequently in dancers and athletes. In both groups individuals tend to complete many reps of the same movements, placing repeated physical stress on the structures of the feet. In addition, they are trained to push through the pain, which raises the risk of accidents.

Sprained Ankle: The injury that’s most likely to lead to a case of cuboid syndrome is a sprained ankle. Inversion strains (where the ankle suddenly rolls over the outside of the foot and the toes twists inward) are far more likely to produce the type of injury associated with cuboid syndrome however eversion strains have been known to cause the condition in some cases.

In a 2006 report, the authors found that as many as 40 out of 100 people who suffered from an inversion ankle sprain can also develop cuboid syndrome.

Pronated or Flat Feet: Cuboid syndrome can be brought on my misalignments in the feet, for example pronated and flat feet. The feet of individuals with pronated feet, roll inward as they walk placing excess pressure on the arch. Pronated feet can be a precursor to fallen arches or flat feet. When the peroneus longus (calf muscles) are overstretched (as is the case in these conditions), they can pull the cuboid bone out of alignment.

Other Risk Factors: The following activities are also linked to the development of cuboid syndrome:

  • frequently participating in sports with rapid, side-to-side movements, such as basketball, tennis and racquetball,
  • going up stairs,
  • wearing shoes that don’t fit well, or shoes without appropriate support,
  • running on uneven surfaces and
  • failing to let your feet recover after strenuous activity.

Cuboid syndrome can lead to pain along the lateral side (outside) of the foot.

Understanding the Causes of Cuboid Syndrome

The cause and diagnosis of cuboid syndrome can be difficult. This is partially due to the fact that in most cases there is no preceding traumatic event like a fall or twist. Usually, cuboid syndrome occurs after repetitive stressful motions, similar to those that an athlete or dancer may execute when training. This is why a detailed personal history is essential in helping your physician understand the condition. Some individuals will recall a step or roll on the lateral side of the foot right before the pain started. 

A lateral ankle or midfoot sprain can result in an injury to the cuboid bone and/or the attached ligaments. As the medical conditions are very different in their underlying physiology, treatment will also be different. Again, a thorough patient history will be used to differentiate between cuboid syndrome and a stress fracture or sprain. Stress fracture and sprains require different treatment modalities. 

If there is no trauma immediately preceding a sharp onset of pain, misalignment of the cuboid bone is a likely culprit. Upon questioning from a medical professional, the patient may recall a quick stop or turn on the outside of the foot in the hours or days prior to the onset of pain.