Cuboid syndrome

What is cuboid syndrome, and how common is it?

Cuboid syndrome is a painful partial displacement (subluxation) of the cuboid, the small bone on the outer side of the midfoot¹². It can cause pain and trouble pushing off when dancing or running¹. It's often reported in ballet dancers and athletes, appears most common in ballet dancers, and is described as common but poorly recognised¹³². It's thought, not proven, to come from disruption of the calcaneocuboid joint². Among athletes screened for foot injuries, roughly 4% had it, while it turned up in 17% of professional ballet dancers who had foot or ankle injuries⁴. Don't assume those figures apply to everyone else.

What causes cuboid syndrome, and who gets it?

Cuboid syndrome may follow an ankle injury or sprain, where the ankle rolls inwards with the toes pointed down⁴⁵⁶. That kind of stress may partly slip the cuboid and cause pain and stiffness in the joint⁶.

Other things may make it more likely: heavy training without enough recovery, training on uneven surfaces, poorly fitting shoes or orthoses, extra body weight and an unstable midfoot⁴. It may be more common in pronated (flatter) feet, but it can also happen in high-arched feet⁴. These are possible contributors, not proven causes. Checking that your shoes fit well and how much you're training are two things you can change.

What does it feel like, and how is it diagnosed?

Cuboid syndrome usually shows up as pain on the outer side of the foot and ankle, less movement at the front of the foot, and a push-off that lacks strength², and dancers may notice pain along the outer midfoot and find they cannot "work through the foot"³. It's often confused with an ankle sprain⁴.

X-rays are of little help in diagnosing cuboid syndrome itself⁷. Diagnosis comes mainly from your history and a hands-on examination of how the bones of your foot move⁷⁶.

Outer-foot pain has other causes, including a break, a dislocation, gout and Charcot foot (a weakening of the foot's bones and joints, linked with diabetes or reduced feeling)⁸. That's why cuboid syndrome shouldn't be assumed without an assessment. Some signs are more serious sooner.

What helps first?

Cuboid syndrome is usually treated by a trained podiatrist, physiotherapist or doctor. The most commonly suggested first step is cuboid manipulation (a hands-on technique by a trained practitioner), unless there's a break or another reason not to⁴. It's often combined with padding, taping or a brace, easing back from activity, and orthoses as supports¹.

Manipulation shouldn't be tried until swelling and bruising have eased, and only by a practitioner who knows the condition⁴. Symptoms may ease straight away, though longer-standing pain may need several sessions⁷. Follow-up checks the bone stays in place.

Cuboid syndrome often responds well to manipulation or external support⁴, though it isn't clear yet which approach works best. Ease off what aggravates the pain, and avoid running or other vigorous weight-bearing for several days after manipulation⁴.

What helps if that isn't enough?

If manipulation brings no relief, the diagnosis needs rethinking rather than repeating the same treatment⁴. The problem may be something else, such as a sprain of the ligaments on the outer midfoot⁴. Where the foot seems unstable, a short period of protection may help, such as a boot or crutches to take weight off the foot⁴¹. A podiatrist or physiotherapist can talk through the options with you, and no option has been shown to be best.

How long does it take to get better, and how do I stop it coming back?

Many people improve quickly once cuboid syndrome is recognised and treated. Athletes who are properly diagnosed and have cuboid manipulation may return to sport within one or two visits⁵. No timeline can be promised.

To help stop it coming back, build training up gradually with enough recovery, and avoid uneven surfaces while it settles⁴. Make sure shoes and orthoses fit well. A podiatrist or physiotherapist can advise on taping, padding, stretching and foot strengthening, which may help prevent it returning⁴.

What can make it serious?

• You have diabetes or reduced feeling in your feet and one foot becomes red, hot or swollen, or suddenly changes shape, even if it doesn't hurt (possible Charcot foot).
• Your foot or ankle looks badly out of shape, or points at an odd angle, after an injury.
• You can't put weight on your foot or take four steps after an injury.
• You think you may have broken a bone in your foot or ankle in an injury, for example you heard a crack, or it swelled or bruised badly within minutes.
• Your foot suddenly looks flatter after an injury.