Physiotherapy for Cuboid Syndrome

Cuboid syndrome refers to a partial dislocation, called subluxation, of the cuboid bone in the foot.

The foot is made of three sections: the forefoot, mid-foot and hind-foot. The mid-foot comprises of small bones including the cuboid bone. The cuboid bone is located in the outer region of the mid-foot and is supported and connected to its neighboring bones through connective tissues that eventually form the joints. These joints support the mid-foot and allow the person to make movements.

While performing weight-bearing activities, certain movements made by the foot may involve the contraction of muscles in the lower leg and hind-foot. This causes increases pressure in the cuboid bone and the tissues surrounding it. Excessive force beyond what the bone and tissues can withstand can lead to the tearing of the connective tissue allowing the cuboid bone to subtly move out of its original alignment. This is a condition called cuboid syndrome.

Causes

Cuboid syndrome normally occurs due to applying excessive pressure on the cuboid from repetitive contractions of the peroneus longus muscles located in the lower leg. Cuboid syndrome may occur along with peroneus longus tendinopathy.

Cuboid syndrome may also occur after a sprained ankle injury due to the excessive turning of the ankle and foot. This causes damage to the connective tissue around the cuboid bone, thus causing cuboid syndrome. People with this condition often have flat/pronated feet, however, this condition may also occur in people with lateral ankle instability. Cuboid syndrome is most common in marathon runners and ballet dancers.

Signs and symptoms

People with cuboid syndrome often experience lateral foot pain that intensifies with weight bearing activity. This may also cause weakness while walking. Pain will worsen while making unguarded or twisting movements, for example while running on hard surfaces with improper footwear.

Pain may also travel to the sole of the foot, the toes or the front of the ankle. Severe cases involve patients having difficulty walking; they are more likely to limp due to the increasing pain. Pain may also increase when pressure is applied firmly to the cuboid bone. Rest may resolve symptoms, unless there is any inflammation. Pain while making the first steps in the morning is also common in patients.

Treatment

Treatment measures usually involve manipulation of the injured bone in order to undo subluxation. This is usually done with the use of taping and protective padding in the region of the cuboid bone.

Patients must rest and avoid physical activity in order to prevent unnecessary pain, until all symptoms have subsided. This can be done with the use of a walking stick, cane or crutches to support movement.

Rest from weight bearing activities will ensure that the body can commence the recovery process without any delay or further tissue damage. Once the patient is symptom-free, he or she may resume normal physical activity.

Treatment within the first 48-72 hours involves taking care of symptoms such as bleeding, inflammation and swelling. This can be done using the R.I.C.E. treatment which allows rest from activities with the use of crutches, regular icing – ideally, for 20 minutes every 1-2 hours, compression bandage and elevation of the affected foot. Nonsteroidal anti-inflammatory drugs can be taken to reduce pain and swelling.

Patients may be instructed to perform no-impact range of motion exercises, balance exercises and strengthening exercises in the rehabilitation regime in order to enhance flexibility and prevent stiffness and weakness from taking place in the foot and ankle. These exercises should be considered once pain allows some physical activity – this should be done under a health care professional’ supervision. A gradual return to normal activity will allow the person to work pain-free, without the flaring up of symptoms and further injury. Orthotics may be required to prevent symptoms. Make sure you wear appropriate footwear to prevent future injuries.

Talk to any of our Perth physiotherapist, call 9272 7359 today!