Lateral Foot Pain – Cuboid Syndrome
Cuboid syndrome is a condition that causes lateral foot pain. In forty percent of cases Cuboid syndrome is associated with lateral ankle sprains (inversion sprain). This syndrome affects the joint (capsule), ligaments, and tendons (peroneus longus tendon).
This syndrome is defined as a “minor disruption or subluxation of the structural congruity of the calcaneocuboid portion of the midtarsal joint”. In laymen’s terms, the cuboid bone has moved from its normal position in the joint.
It is a common syndrome, but not well-recognized by practitioners. Cuboid syndrome also goes by several other names: subluxated cuboid, dropped cuboid, cuboid fault syndrome, and lateral plantar neuritis.
Anatomy and Biomechanics
The calcaneocuboid joint is a vital link in lateral foot stability. This joint is susceptible to sudden injury or chronic strain, which can cause this joint to partially dislocate or subluxate.
The cuboid bone is one of the seven tarsal bones of the foot.
Causes of Cuboid Syndrome
A single impact injury or repetitive motion can cause this syndrome to occur. Runners and dancers (especially ballet dancers) are susceptible to this injury because of the high levels of repetitive impact. In addition basketball players or racquet sport players also are susceptible due to the lateral motions required to play these sports.
If a person abnormally pronates their foot during the push off phase of gait, they will be more susceptible to a cuboid injury. Excessive pronation causes an increase in force transferred to the cuboid bone which causes instability and a resultant injury.
Symptoms and Diagnosis of Cuboid Syndrome
Patients who have cuboid syndrome often complain of lateral foot pain, or weakness in their feet. Pain from cuboid syndrome can also radiate to the front of the ankle. This pain is often more noticeable during time of exertion (toe-off portion of the gait cycle), or on impact. The type of pain found in cuboid syndrome may not be a very good indication of this condition. Pain can be intermittent, or persistent, it can also develop suddenly or slowly over a period of time.
Diagnosis and Imaging
Upon physical examination, the patient may have pain directly over the cuboid bone (especially when pressure is applied dorsally on the plantar surface). In some cases there may be bruising, redness and swelling. Range of motion in the ankle is often limited in cuboid syndrome (dorsi and plantar flexion).
X-rays, CT scans or MRIs are of little value in the diagnosis of cuboid syndrome. The reason an X-ray is of value in the diagnosis of this syndrome is to rule out fractures or some type of pathological condition.
Treatment of Cuboid Syndrome
Several forms of manual therapy can be used in treating this condition. The sooner that treatment is implemented the faster the results will be.
One of the most successful treatments we have found is manual manipulation. A therapist training in extremity manipulation (chiropractor, physiotherapist, podiatrist) can often reduce the pain of cuboid syndrome in a short period of time.
Soft Tissue Techniques
Techniques such as Motion Specific Release, Active Release, Graston, Massage Therapy, and Fascial Manipulation can also be of great help. The key is to work with all of the structures involved in the kinetic chain, not only at the site of pain.
Exercises should focus on stretching the peroneus longus and the calf muscles.These stretches are combined with strengthening the extrinsic muscles of the foot. In addition, it is essential to perform balance exercises so that the injury does not reoccur.
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for a specific exercise needed to rehabilitate this injury.
Custom fit orthotics will help to correct abnormal pronation and supination that may be leading to cuboid syndrome.