Houston Methodist. Leading Medicine

Foot FAQ

Question:

I saw a physical therapist for a foot problem I've been having. She says it's something called a cuboid syndrome. She wants to manipulate the joints and get them back in line with each other. Should I go ahead with this treatment? I did have an X-ray so I know that nothing is broken. But nothing else showed up either.

Answer:

Physical therapists are well-trained to handle musculoskeletal injuries and problems such as cuboid syndrome. They understand the anatomy, mechanics during standing and walking, and clinical presentation associated with this condition. And by the way, other names for cuboid syndrome are cuboid fault syndrome, dropped cuboid, subluxed cuboid, locked cuboid, peroneal cuboid syndrome, and lateral plantar neuritis. Manipulation is the first line-of-treatment for cuboid syndrome. A little anatomy will help you understand the problem and the treatment. The cuboid bone is one of many bones in the foot. It is situated close to the center of the foot and is surrounded by other bones. It is an oddly shaped bone with smooth places (the articular surfaces) where the other bones connect and are held together by ligaments and tendons. The main area where the cuboid bone makes contact with the calcaneus (heel bone) is called the calcaneocuboid (CC) joint. This is an important joint for stability, load transfer, and movement of the foot and ankle. As some of the names for this condition suggest, a shift in the position of the cuboid bone can cause loss of motion with the bone "locked" in place. The surfaces of the connecting bones no longer line up. This effect with the accompanying symptoms is a cuboid syndrome. When this happens, we say the joint has lost its congruence. The loss of congruence can be small enough that it doesn't show up on an X-ray or other types of imaging studies. Pain develops along the lateral side of the foot. It feels like a ligament sprain. Loss of ankle and/or foot motion is common. Putting weight on the foot (especially the outside edge of the foot) becomes difficult. The ability to stand, walk normally, or hop on the painful foot is affected. Lateral foot pain could be caused by a number of other problems. The list of possible sources of lateral foot pain includes gout, compression neuropathy of the sural nerve, ankle impingement, tendinopathy, or congenital fusion of the bones in that area (calcaneus, navicular, talus). Cuboid syndrome is clearly a mechanical problem but one that could be caused by impaired muscle or tendon function, faulty anatomy such as flat feet, being overweight, or wearing the wrong kind of shoes. Other factors that may increase the risk of developing cuboid syndrome include poorly constructed orthotics (shoe inserts), training on hard or uneven surfaces, and overtraining without enough rest or time to recover. Your therapist will likely review your case for any of these risk factors and work with you to reduce your risk of re-injury. During a cuboid manipulation, the therapist holds the foot to stabilize the bones around the cuboid and then applies a force to shift the bone back in place. Two techniques used to manipulate the cuboid are called the cuboid whip and the cuboid squeeze. Neither of these movements is painful. You may feel and/or hear a click or pop. Immediate pain relief is often reported after manipulation. It may take more than one manipulation to completely resolve the problem. The longer the syndrome has been present, the more likely that a series of manipulations will be needed. Manipulation may be followed by local treatment such as icing, taping, ultrasound (heat), massage, or electrical stimulation. The therapist will also likely show you stretching stretching exercises for the leg muscles. Shoe inserts to support the cuboid bone may be provided. In cases of acute (recent) ankle/foot sprain with swelling and bruising, a high-velocity thrust manipulation may not be appropriate. It may be better to apply this treatment method after the injured soft tissues have had time to heal and can withstand the force of a manipulative movement. If the treatment for cuboid syndrome is applied and the symptoms go away, the diagnosis may be confirmed. If you do not respond to this proposed treatment, you may have some other problem. At that point, reevaluation is required. It may be that there is a sprain severe enough to require unloading with a cane or crutches or off-loading in a cast or splint. Your therapist will guide you through this decision-making process. Don't hesitate to ask her this very question that you have posed here. Chris J. Durall, DPT, ATC, MSPT. Examination and Treatment of Cuboid Syndrome: A Literature Review. In Sports Health. November/December 2011. Vol. 3. No. 6. Pp. 514-519.

*Disclaimer:* The information contained herein is compiled from a variety of sources. It may not be complete or timely. It does not cover all diseases, physical conditions, ailments or treatments. The information should NOT be used in place of visit with your healthcare provider, nor should you disregard the advice of your health care provider because of any information you read in this topic.
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