What is cuboid syndrome?
Cuboid syndrome is a medical term used when the ligaments or joint capsules that connect to the cuboid have been injured by being overstretched or torn to the extent that two or more connecting bones have become dislodged and are no longer aligned as they should be. Cuboid syndrome is normally a partial dislocation or sometimes referred to as a subluxation of the cuboid bone, which is located on the outside edge of the mid foot just below the ankle. The foot itself is made of three sections of different bones. The bones at the back of the foot under the ankle joint are known as the tarsal bones which include; the calcaneus (which forms your heel), the talus (which forms part of the ankle), navicular, cuboid, and the lateral, intermediate and medial cuneiforms. The next section is the mid foot consisting of the five long metatarsal bones, numbered in the sense that your big toe is first and your little toe is your fifth. The metatarsals connect at the back to the cuneiforms, navicular and cuboid bones and at the front to the toes. The toes are the last section, consisting of five bones called phalanges which like the fingers are individually divided into three bones (distal, middle and proximal), the big toe is referred to as the hallux and has only two bones. The cuboid bone plays an important role in the biomechanics of the foot. It contributes to and supports the structure of the foot arch, thus affecting balance, supporting weight-bearing stances and also providing the attachment point for many important lower leg and foot muscles.
Why and when does cuboid syndrome happen?
Cuboid syndrome is most commonly seen in young people who participate in athletic sports. The dislocation normally occurs as the result of a gradual build up in tension from the connecting lower leg and foot muscles or from one traumatic incident. Typically during sports such as running and ballet there are large forces placed through the foot or in quick movement sports like tennis and basketball where players are quickly changing direction, the muscles that attach to the cuboid bone become overused and tighten. These activities all increase the stress placed upon the cuboid bone joints and attachments. This repetitive pressure can be forceful enough to damage and tear the surrounding ligaments or joint capsule causing the support around the cuboid bone to slacken, allowing the cuboid to dislodge and dislocate. Landing awkwardly from one jump or dance move can sometimes create enough strain to dislocate the cuboid there and then and often cuboid dislocations are seen as a result of a severe ankle sprain. Just as important a factor to consider is the biomechanics of the foot. Many cases of cuboid syndrome are the result of flat fleet when the arches of your foot have fallen and in some cases when arches are too high. Poor foot posture changes the way in which you walk and the way in which your body weight is distributed through your foot. This can put disproportionate pressure through the cuboid bone and also increase the stress through the lower leg muscles. Wearing inappropriate and unsupportive footwear and training on hard, unforgiving surfaces can both be factors in development of the syndrome.
What does cuboid syndrome feel like?
Cuboid syndrome can either develop gradually with repetitive strain or there can be sudden onset of pain after trauma. With repetitive strain there is a gradual onset of a dull ache around the cuboid on the outside edge of the foot. This pain can radiate down into the sole of the foot and up into the ankle. The pain levels will initially feel quite low but will most likely be aggravated by sporting activities that include impact through the foot, such as running, football, dancing and in particular anything that involves standing on tip toes. There may be a small amount of swelling and bruising and in severe cases the foot will feel weak when walking and running, especially when the toes go to push off the ground. In these cases the pain levels will be aggravated by most weight-bearing ankle and foot movements and patients may walk with a slight limp. If there has been sudden onset after landing awkwardly or a sprain then there will be sudden, severe, sharp pain around the cuboid. The initial intense pain will ease with rest but once the healing process starts there will be a dull, continuous ache from the swelling and healing that will last weeks to months. The muscles that attach to the cuboid bone will be tight and contracted and may create stiffness and muscle pain around the shin, calf and ankle areas.
What to do if cuboid syndrome is suspected?
Actions taken immediately after a dislocation can greatly improve recovery and reduce pain levels. As soon as the injury is sustained follow the R.I.C.E protocol. This involves resting your foot, try not to walk about on it too much and if you have to then ensure you are wearing shoes that aren’t too tight over the foot but that still provide protection. Ice, applying a covered ice pack to the area may also significantly hasten the healing process by reducing the pain and swelling. Make sure the ice pack is covered to prevent any ice burn and for best results use the ice-pack regularly for 10-15 minutes with intervals of 30 minutes. Compression, try and keep the elastic bandage on during the day to limit the swelling and ensure you take it off at night. Elevation, keep your foot raised on cushions or a stool to help limit the swelling. You should seek medical attention straight away in order to have the joint reset to its proper alignment.
How will cuboid syndrome be diagnosed?
Your GP or therapist will be able to fully diagnose you by both listening to your history and examining you. A full examination will be done to rule out any additional injuries or complications and your doctor may order an X-ray of the foot to confirm the diagnosis and identify the location and the extent of the dislocation, however this isn’t always necessary.
What treatment options are available for cuboid syndrome?
The treatment options and healing times for cuboid syndrome vary depending on how quickly it is diagnosed, treated, the severity of the dislocation and also on the complications from any additional injuries. Most cases of cuboid syndrome are reset by manipulating the cuboid bone back into place. Many people find manipulative therapies such as physiotherapy, chiropractic or osteopathy useful for this. The cuboid bone should be reset quickly and the foot should then be taped and bandaged to help support and maintain the structure. Patients will initially have to rest and avoid aggravating activities. In severe cases it may be necessary to avoid weight bearing and use crutches, a boot splint or a cast to reinforce and stabilise the dislocation until it is well healed. The doctor will most likely prescribe anti-inflammatory medication to reduce any swelling and painkillers for pain relief. Patients may be referred to a physiotherapist who will provide exercises to strengthen the ankle and foot muscles and ligaments to aid the healing process. It is vital that during the healing process the patient still moves around as much as possible to reduce the risk of a DVT. Fluctuating pain levels will be experienced throughout the healing process however most of the discomfort towards the end of the healing process comes from stiffness levels caused by long term immobility. If you have not been provided with strengthening and balance exercises for the foot then you should actively seek them out from a therapist as this will affect your long term recovery. The rehabilitation exercises as well as massage and some manipulative therapies will aid in recovering foot and ankle flexibility and will help prevent the injury from recurring.
In most cases of cuboid syndrome the pain eases immediately once the bone is reset. It is still advisable that you avoid any strenuous sports for a week or two and then gradually return to your normally level of activity. The healing timeframe can be much longer for those severe cases where there are multiple injuries.
If your GP has mentioned or if in fact you feel that there is some element of poor foot posture that has predisposed you to this injury then it is very important that you see a podiatrist who can fully examine your feet and determine whether you need orthotics for your shoes. The podiatrist should also be able to provide you with advice on more appropriate and supportive training shoes. The failure to remedy these problems may result in a prolonged recovery or recurring cuboid dislocations.