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.

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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.

Cuboid syndrome is not rare among the general population, but it is most common among endurance athletes, gymnasts, dancers and in sports involving large loading forces on the cuboid.

When doctors correctly identify and treat cuboid syndrome, most people make a full recovery.

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

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 injuries.

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

Sprained ankle

Inversion ankle sprains are another common injury resulting in cuboid syndrome. This happens when the ankle suddenly twists inward, although outward twists have also been known to cause the condition.

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

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 carrying excess weight might be more likely to develop cuboid syndrome due to the extra pressure placed on the bones of the foot.

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 (MRI), 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, 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.

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

  • A person lies on their back with the knee of the injured foot bent, while the therapist holds the injured foot.
  • A person straightens their 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.

  • A person lies with their 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 soon after the injury. If the pain has gone on for an extended period, the injury may require many manipulations.

Doctors do not recommend foot manipulation 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

Doctors rarely recommend surgery for this condition. However, they may suggest it when other treatment options have not brought relief.

Recovery time 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, people may begin to feel relief within a few days. However, if a person has other injuries, such as an ankle sprain, healing can take longer. A physical therapist can give a clearer idea of how long a person’s recovery may take.

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.

Cuboid syndrome happens when the cuboid bone, in the middle of the foot, shifts out of place. It causes pain on the outside of the foot and may make walking difficult.

Rest is the first-line treatment for cuboid syndrome. It may be necessary for a physical therapist or podiatrist to use manipulation to pop the bone back into place. Exercises to stretch and strengthen the foot and calf muscles may also help.