With the Melbourne Marathon getting closer, Melbournians are starting to ramp up their training volume. As a result, running injuries become more and more present. A commonly misdiagnosed injury of foot is Cuboid syndrome and accounts for approximately 4% of all foot injuries.
What is Cuboid Syndrome?
Cuboid syndrome is injury that results in pain in the mid-foot region. Cuboid syndrome is poorly understood in terms of what the exact cause of pain is. However, we know that the injury affects the joint capsule of the calcaneocuboid (CC), ligaments of the foot/ankle and the peroneus longus tendon.
The likely mechanism of injury for Cuboid syndrome is:
1. Acute inversion injury (e.g. sprained ankle)
2. Overuse injury (e.g. runners)
Biomechanics of Cuboid Syndrome
There are various biomechanical factors that may predispose you to cuboid syndrome. This also includes running technique; therefore running analysis may be necessary in some cases. Factors that increase the likelihood of cuboid syndrome include:
· - Mid-foot instability
· -Excessive bodyweight
· -Poor load management
· - Unsuitable foot orthoses or shoes
· -Previous acute ankle injuries
· -Supinated foot strike during running
What are the symptoms of Cuboid Syndrome?
The most obvious symptom is pain on the lateral (outside) plantar aspect (underneath) of the foot. This pain is most prominent during weight bearing, which may include: walking, running or hopping. Depending on the severity of the injury will determine how much weight can be tolerated through the foot. There is likely to be tenderness on cuboid bone as well as along the peroneals (muscles on outside of your leg) and extensor digitorum brevis muscle. There may be decreased range of motion and difficulty performing change of direction due to the pressure on the outside of the foot.
If Cuboid syndrome is a result of an acute ankle sprain, the above presentation will be associated with symptoms caused by the ankle injury. Therefore, increased swelling and pain on the lateral aspect of the ankle joint is expected.
Is the Cuboid bone truly subluxated?
There is dividing belief in regards to whether the cuboid bone is truly “subluxated”. This term refers to the incomplete or partial dislocation of the joint. There are multiple sources that suggest a manipulation such as the cuboid whip or cuboid squeeze be used to treat this condition. Some sources even suggest a “pop” can be heard during this technique. It is possible for this to be true; however in most cases, this is unlikely to occur. The cuboid bone may be displaced, but only by small margins. Therefore, the term subluxation may not be the most appropriate for describing this condition.
How do you manage Cuboid Syndrome?
There are multiple ways to address cuboid syndrome. Your physiotherapist will help identify the most significant factors for you. Initially, it is important to assess the condition to ensure the diagnosis. There are other foot injuries that present similarly such as: stress fractures, peroneal tendinopathy, plantar fasciitis, gout, lisfranc injury or antero-lateral ankle impingement. Once diagnosed, the physiotherapist will aim to reduce pain and inflammation in your foot. This can be achieved by mobilisation of the calcaneal-cuboid joint, ankle mortise and other mid foot joints. Soft tissue massage can be used on the peroneals and muscles (tendons) of the foot.
Other important management strategies may include load management, footwear adjustments and biomechanical modification.