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Cuboid syndrome is a cause of lateral midfoot pain, believed to result from abnormal articulation of the cuboid with the calcaneus (calcaneocuboid joint).
Cuboid syndrome presents with lateral foot pain and swelling, often diffuse and similar to an ankle (ligament) sprain 1,2. Pain is often aggravated by weightbearing and side-to-side movements 1.
Midtarsal adduction (stressing the midtarsal joint by superior-inferior manipulation of the midfoot against a stabilized hindfoot) and supination tests (inversion and plantar flexion of midfoot against stabilized hindfoot) tend to reproduce the symptoms 1.
Although the mechanisms are debated, the syndrome is believed to be secondary to repeated or forceful eversion of the cuboid relative to the calcaneus, resulting in disruption of the calcaneocuboid joint 1,2.
The mechanism of the peroneus longus is implicated as a contributing factor, as the tendon wraps around the cuboid and is responsible for cuboid eversion. The peroneus is thought to aid in load transfer from lateral to medial forefoot during normal stride 1.
Injury to the joint may co-occur during an ankle ligament sprain, which may be a cause of persistent pain surpassing typical sprain symptoms 2.
Thus, the primary role of imaging is to exclude other causes of lateral foot pain, e.g. fracture 1.
Treatment and prognosis
Treatment of incongruous calcaneocuboid joint may involve rapid manipulation to reduce the joint. This consists of firmly grasping the foot at the level of the cuboid, and subsequently quickly forcing plantarflexion, slight subtalar supination (inversion) of the foot to "whip" the lower extremity 3.
Other causes of lateral foot pain include 1:
- fracture/dislocation of other lateral foot structures:
- ankle sprain
- calcaneonavicular coalition
- plantar fasciitis
- sinus tarsi syndrome
- anterolateral ankle impingement
- peroneus longus
- extensor digitorum brevis
- neuropathy (compressive)
- 1. Durall CJ. Examination and treatment of cuboid syndrome: a literature review. (2011) Sports health. 3 (6): 514-9. doi:10.1177/1941738111405965 - Pubmed
- 2. Zapf AD, Morgan C, Herman DC. Recognizing Cuboid Syndrome. (2018) Current sports medicine reports. 17 (1): 6. doi:10.1249/JSR.0000000000000437 - Pubmed
- 3. Martin C, Zapf A, Herman DC. Cuboid Syndrome: Whip It Good!. (2017) Current sports medicine reports. 16 (4): 221. doi:10.1249/JSR.0000000000000373 - Pubmed