Cuboid Syndrome — Symptoms, Causes & Treatment

Cuboid syndrome, also known as cuboid subluxation or cuboid subluxation syndrome, is a condition where one of the small bones in the foot, called the cuboid bone, becomes displaced from its normal position. This can cause pain and discomfort in the foot, particularly on the outer edge.

The symptoms vary from person to person, some of them include:

• Pain and tenderness on the outer edge of the foot, particularly when walking or standing.
• Swelling or redness around the affected area.
• Difficulty moving the foot or toes.
• A feeling of instability in the foot.
• A clicking or popping sensation in the foot.

The exact cause of the cuboid syndrome is not always clear, but it is often associated with overuse or injury to the foot, such as from running, jumping, or wearing tight or ill-fitting shoes. Other factors that may contribute to the development of cuboid syndrome include:

• Sudden twisting or turning of the foot.
• Ankle sprains or other injuries to the foot or ankle.
• Abnormal foot structure or mechanics, such as flat feet or high arches.
• Poor posture or gait.
• Repetitive stress or strain on the foot, such as from certain occupations or activities.

Pathology:
The cuboid bone is located on the lateral side of the foot, between the heel bone and the fourth and fifth metatarsals. It forms a joint with the heel bone and helps to support the weight of the body during standing and walking. When the cuboid bone is displaced, it can cause irritation and inflammation of the surrounding soft tissues, including the ligaments, tendons, and nerves. This can lead to pain, swelling, and difficulty walking.

Physical Examination:
The physiotherapist may perform a physical examination to check for tenderness, swelling, and limited range of motion around the cuboid bone.

Special Tests:
Various special tests may be performed, including the Cuboid Compression Test, the Cuboid Subluxation Test, and the Midtarsal Adduction Test, which help reproduce the symptoms of cuboid syndrome.

Imaging Studies:
X-rays, CT scans, or MRI scans can help identify any abnormalities in the bones, ligaments, tendons, or soft tissues surrounding the cuboid bone.

Electromyography (EMG):
EMG can help diagnose cuboid syndrome by measuring the electrical activity of the muscles surrounding the cuboid bone.

Nerve Conduction Study:
This technique measures how quickly the nerves in the foot transmit electrical impulses, which can help identify any nerve-related issues.

Medication: Nonsteroidal Anti-Inflammatory Drugs (NSAIDs), Acetaminophen, Topical Analgesics. etc.
Note: Medication should not be taken without the doctor’s prescription.

Surgery:
Surgery is rarely necessary for the treatment of cuboid syndrome and is usually only considered in severe cases that do not respond to conservative treatments. Surgery for cuboid syndrome may involve the following procedures:

• Cuboid Release Surgery: This procedure involves releasing the plantar fascia (the tissue that supports the arch of the foot) to relieve pressure on the cuboid bone. The surgeon may also remove any damaged tissue or reposition the cuboid bone to its correct position.
• Cuboid Osteotomy: This procedure involves cutting the cuboid bone to reposition it correctly, and then fixing it in place with screws or other devices. The surgeon may also remove any damaged tissue and repair any ligament or tendon injuries.
• Arthroscopy: This procedure involves using a small camera and surgical instruments inserted through small incisions to visualize and repair any damage to the joint surfaces of the foot.

Rest and Cryotherapy:
The patient is encouraged to rest and apply ice to the affected area to help reduce pain and inflammation.

Transcutaneous Electrical Nerve Stimulation (TENS):
TENS is a non-invasive technique that involves applying low-level electrical currents to the skin to relieve pain. TENS may be used to help reduce pain and inflammation in the foot.

Ultrasound Therapy:
Ultrasound therapy involves using high-frequency sound waves to generate heat and promote healing in the affected area. It may be used to increase blood flow to the foot and promote tissue repair.

Electrical Muscle Stimulation (EMS):
EMS involves using electrical currents to stimulate the muscles in the affected area. This may help improve muscle strength and reduce pain.

Interferential Current Therapy (IFT):
IFT involves applying two electrical currents of different frequencies to the affected area. This may help reduce pain and inflammation and promote tissue healing.

Shockwave therapy:
Shockwave therapy may also be used to help manage pain and inflammation in the foot, mobility in the affected foot

Pulsed Electromagnetic Field Therapy (PEMF):
PEMF involves using low-frequency electromagnetic fields to stimulate the cells in the affected area. This may help reduce pain, inflammation, and promote tissue healing.

Range of Motion (ROM) Exercises:
These exercises help to maintain flexibility and mobility in the affected foot. ROM exercises may include gentle stretches, rotations, and other movements to improve joint mobility.

Strengthening Exercises:
Strengthening exercises can help improve muscle strength in the foot and ankle. This can help to improve stability and reduce the risk of re-injury.

Balance Training:
Balance training exercises can help improve balance and stability in the foot and ankle. This can help reduce the risk of falls and improve overall foot function.

Gait Training:
Gait training involves analyzing how a person walks and identifying any abnormalities or imbalances. The physiotherapist can then develop a treatment plan to help correct these issues and improve gait and walking function.

Manual Therapy:
Manual therapy techniques, such as massage, joint mobilization, and soft tissue manipulation, may be used to help relieve pain, reduce inflammation, and improve mobility in the affected area.

Taping and Bracing:
Taping or bracing may be used to support the foot and ankle and help reduce stress on the affected area. This can help to reduce pain and inflammation and promote healing.

The patient should be advised to wear proper footwear that provides support and stability for the foot. Encourage the patient to avoid high heels and tight-fitting shoes and also avoid activities that cause pain or discomfort, such as running or jumping. Instead, suggest alternative activities that are less likely to aggravate symptoms, such as swimming or cycling.