Cuboid syndrome is a condition caused by an injury to the joint and ligaments surrounding the cuboid bone. The cuboid bone is one of the seven tarsal bones in the foot.

Cuboid syndrome causes pain on the lateral side of the foot which is the side of the little toe. A person often feels pain around the middle of the foot, or at the base of the fourth and fifth toes.

It is often hard to tell exactly where this pain comes from, which makes cuboid syndrome challenging to diagnose. It can be confused with a stress fracture, but stress fractures are rare in the cuboid bone.

In this article, learn more about the causes, symptoms, diagnosis, and treatment of cuboid syndrome.

What is cuboid syndrome?

The cuboid bone in the foot which may cause cuboid syndrome
The cuboid bone is one of the tarsal bones of the foot, and cuboid syndrome is when the cuboid bone moves out of alignment.
Image credit: DBCLS, 2013

Cuboid syndrome is the result of partial dislocation of the bones in the middle of the foot.

Medically, this is called subluxation of the midtarsal joint.

Specifically, cuboid syndrome develops when the cuboid bone moves down and out of alignment with the other bone in the joint, the calcaneus bone.

This might happen after a sudden injury or overuse of the foot joints.

How common is cuboid syndrome?

Reports indicate that while cuboid syndrome is not rare among the general population, it is more common among athletes and dancers. A 2011 study found that 4 percent of the athletes who had foot injuries had problems with the cuboid area.

When cuboid syndrome is correctly identified and treated, most individuals make a full recovery.

Symptoms and diagnosis

Cuboid syndrome causes pain on the lateral side of the foot. The pain may come on suddenly or develop slowly over time.

The following are common symptoms of cuboid syndrome:

  • pain on the lateral of foot, which is the side of the little toe
  • pain gets worse with weight-bearing
  • pain can be dull and aching, or sharp and acute
  • difficulty walking
  • hopping is very difficult
  • possible swelling
  • pain can be worse when lifting the heel and pushing off the toe
  • reduced range of motion of foot and/or ankle
  • sensitivity on the bottom of the foot
  • referred pain to outside of ankle

Causes

Dancers in a studio are most at risk of cuboid syndrome
Dancers and athletes are most at risk of cuboid syndrome.

Causes of cuboid syndrome may include:

Overuse

The most frequent causes of cuboid syndrome are overuse or injury.

This explains why cuboid syndrome occurs most often in athletes and dancers. Members of both groups have a tendency to work through pain, and are intensely active in high stress situations, which increases the risk of accidents.

Overuse injuries tend to develop after frequent extended periods of intense activity, such as running.

Sprained ankle

The injury most likely to lead to cuboid syndrome is an inversion sprain of the ankle. This happens when the ankle suddenly twists inward, although outward twists have also been known to cause the condition.

A 2006 study found that as many as 40 percent of people with inversion ankle sprains might also have developed cuboid syndrome.

Pronated feet

Cuboid syndrome might also be more common in people with pronated feet, which means that their feet turn inward as they walk. When a person’s calf muscles (peroneus longus) are particularly tight, they can tug the cuboid bone out of place when the foot is pronated.

Other activities

The following factors have also been associated with this condition:

  • playing a lot of sports with rapid, side-to-side movements, such as tennis and racquetball
  • climbing stairs
  • wearing poorly fitting shoes, or shoes without adequate support
  • training on uneven surfaces
  • neglecting the need for rest and recovery after strenuous activity

Treatment

Treating cuboid syndrome begins with rest, and reducing or eliminating activity that involves putting weight on the foot.

Home treatments include RICE therapy, which is an acronym for rest, ice, compression, and elevation.

If the pain persists or worsens, individuals should see a doctor or physical therapist. A trained professional can perform certain foot manipulations to resolve cuboid syndrome, including:

The cuboid whip

  • Lie on your back with the knee of the injured foot bent, while the therapist holds the injured foot.
  • Straighten your knee quickly with the foot flexed. The therapist pushes forcefully on the cuboid bone from the bottom of the foot to pop it back into place.

Some people may hear the bone popping into place, although the treatment does not have to be audible to work.

The cuboid squeeze

This method seems to work better if cuboid syndrome pain is worse on top of the foot.

  • Lie with your leg relaxed and off the edge of a table, while the therapist holds the foot, flexes it, and pushes on the cuboid from the top of the foot.

Manipulation of the cuboid bone works best if it is done within 24 hours of the injury. If the pain has gone on for an extended period, the injury may require many manipulations. However, according to a 1997 textbook, manipulations may be successful 90 percent of the time.

Foot manipulation is not recommended if an individual is also dealing with other conditions, such as arthritis, a broken bone, circulatory or nerve problems, or bone disease.

Additional treatments for cuboid syndrome include:

  • using a pad to stabilize the joints in the middle of the foot
  • taping the foot to help keep it stable
  • wearing orthotics to support proper alignment
  • taking anti-inflammatory medications to reduce pain and swelling
  • deep-tissue massaging of calf muscles, which may be pulling on the cuboid bone

Surgery is rarely recommended for this condition, and only when other treatment options have not brought relief.

Recovery

Foot brace for a person with cuboid syndrome
A foot brace to provide support may be recommended for a person with cuboid syndrome.

The length of time it typically takes to recover from an episode of cuboid syndrome depends on many factors including:

  • how long the individual has had the injury
  • whether it was caused by an acute injury or developed over time
  • if it developed as part of another injury, such as a sprained ankle.

If the original injury was small, most people begin to feel relief within a few days. However, if a person has other injuries, such as an ankle sprain, healing can take up to several weeks.

Physical therapy can play an essential role in promoting full recovery from the effects of cuboid syndrome. It can also help prevent further injury. Physical therapy includes:

  • strengthening the foot
  • stretching the foot and calf muscles
  • exercises to improve balance

In some cases, a doctor or therapist may recommend using an ankle or foot brace to provide support and stability for the foot and ankle.

Diagnosis

The foot is a complex, flexible, and durable part of the body. It contains around 100 muscles, ligaments, and tendons, 28 bones, and 30 joints

The complicated structure of the foot and the non-specific nature of cuboid syndrome pain make this injury difficult to diagnose.

Sometimes, medical imaging techniques, such as X-rays or magnetic resonance imaging (MRIs), do not identify any signs of cuboid syndrome, even when the condition is present.

Cuboid syndrome can also mimic the symptoms of other foot problems, such as a stress fracture or heel spurs.

Cuboid syndrome can also develop at the same time as a stress fracture in another part of the foot. However, studies say stress fractures of the cuboid bone itself are rare because the cuboid bone does not bear weight.

To make a diagnosis and find the most effective treatment, a doctor will perform a thorough physical exam and review a person’s medical history.

Risk factors

Athletes, dancers, and other individuals who ask a lot of their feet by engaging in high impact activities with repetitive motion may be at highest risk for developing cuboid syndrome.

Also, someone who is significantly overweight might be more likely to develop cuboid syndrome due to the extra pressure placed on the bones of the foot.

Outlook

The outlook is typically very favorable for people with cuboid syndrome. Following treatment, most people can return to all activities, with very little risk of a recurrence.