Cuboid Syndrome

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The cuboid bone is one of the 26 bones of the foot. It is located on the lateral (outside) side of the foot, about halfway between the pinky toe and the heel bone. The cuboid bone moves and shifts to a minor degree during regular foot motion. Certain forceful movements or prolonged positions can cause the cuboid bone to move too far, thus interfering with its normal position or motion. This causes immediate foot pain, which can worsen when standing or walking on the foot.

Cuboid syndrome is a condition caused when the cuboid bone moves out of alignment. It is most often the result of injury or trauma to the joint and / or ligaments surrounding the small tarsal bone. Cuboid syndrome causes discomfort and pain on the lateral side of the foot. The pain is most often felt around the center of the foot favoring the side where the pinky toe (fifth toe) is located. It has also been reported close to the base of the fourth and fifth toes. Most commonly, patients sometimes report difficulty in identifying the exact location of the pain.

Therefore, this can make diagnosing cuboid syndrome difficult. It can sometimes be misdiagnosed as a stress fracture (also known as a cuboid stress fracture), even though stress fractures in the cuboid bone are rare (a stress fracture is a small crack in a bone or severe bruising within a bone). Most stress fractures are caused by overuse and repetitive activity and are common in runners and athletes who participate in running sports, such as soccer and basketball; damaging the cuboid bone may also be a cause due to these sports activities.

Overall, a cuboid bone injury can develop from maintaining prolonged foot positions, such as walking in high heels or remaining in a toe-pointed position for a long time. Peroneal tendon problems, such as weakness, tendonitis, or tendinopathy, can also contribute to, or occur at the same time as cuboid syndrome.

Causes & Symptoms

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Cuboid syndrome can play a role in many types of causes. Most are associated with injuries from sporting activities and / or repetitive walking and running which may increase the possibility of injuring your cuboid bone. Therefore, cuboid syndrome may be caused by the following below:

 

Overuse

One of the most common causes of cuboid syndrome is overuse. Cuboid syndrome seems to occur most frequently in dancers and athletes. In both groups, individuals tend to complete many repetitions of the same movements, placing repeated physical stress on the structures of the feet. In addition, they are trained to push through the pain, which raises the risk of accidents.

Sprained ankle

The injury that is most likely to lead to a case of cuboid syndrome is, a sprained ankle. Inversion strains (where the ankle suddenly rolls over the outside of the foot and the toes twists inward) are far more likely to produce the type of injury associated with cuboid syndrome; however, eversion strains have been known to cause the condition in some cases too.

Pronated or flat feet

Cuboid syndrome can be brought on by misalignments in the feet, such as, ‘pronated’ or ‘flat feet’. The feet of some people with pronated feet, roll inward as they walk placing excess pressure on the arch. Pronated feet can be a precursor to fallen arches or flat feet. When the peroneus longus (calf muscles) are overstretched, they can pull the cuboid bone out of alignment.

Symptoms linked to cuboid syndrome first present as discomfort or pain on the lateral side of the foot – some patients report a sudden onset of pain, while for others it develops slowly over time. Pain associated with cuboid syndrome usually include:

  • Pain that is focused on the lateral side of the foot.
  • Pain that can be either sharp and acute, or dull and aching.
  • Discomfort increased when weight is placed on the foot.
  • Having trouble walking, running, hopping, and jumping.
  • Experience rapid swelling.
  • Pain increased when standing on your toes.
  • Reduced range of motion.
  • Pain that may radiate to the outside of your ankle.

Who gets Cuboid Syndrome?

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As mentioned earlier, when the joints or ligaments surrounding the cuboid bone in your foot are injured or torn, it is possible you may be developing cuboid syndrome. Certain forms of arthritis may increase your chances of getting this condition, such as osteoarthritis and gout.

Some more common risk factors linked to cuboid syndrome include:

  • Obesity – People who are overweight are more prone to developing cuboid syndrome due to adding an excessive amount of stress on the bones of their feet.
  • Unsupportive footwear – Wearing footwear that is too tight or lacks support and using them during sporting activities may increase the chances of getting cuboid syndrome.
  • Lack of stretching – Not stretching before working out will add extra stress onto your feet, thus leading to greater potential for general cuboid bone damage.
  • Running on hard surfaces – Running on surfaces such as sidewalks / pavements and uphill will increase the possibility of the condition.
  • Sports – Certain sports require repetitive movement, including basketball, soccer, ballet, tennis, and racquetball.

How Does it Affect You? How Serious is it?

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Injuries damaging the cuboid bone can lead to fractures, which are classified from minor to severe. In severe cases, the cuboid bone can rupture completely which may require you to undergo foot surgery. Foot surgery can be a success for many patients; however, surgery comes with the risk of complications. Here is a list of some of the most common complications:

  • Infection – There is a small risk of infection regarding surgery on the foot. However, if you do get an infection, a podiatrist can recommend you take an antibiotic. In rare cases, a serious infection can result. Serious infections can be fatal if they are not treated.
  • Deep vein thrombosis – Deep vein thrombosis after foot surgery can result because of prolonged immobilization.
  • Delayed healing – Healing time can vary from person to person. However, the healing process can take much longer than expected.
  • Scarring – Every surgery can cause scarring. The scarring is typically short-term, but it may also cause long-term visibility.
  • Recurrence – Even though foot surgery is a success for most patients living with cuboid syndrome, there is a chance that the problem may reoccur.

Recommended Treatment & Rehabilitation

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During a diagnosis to treat cuboid syndrome, a physiotherapist will begin a thorough evaluation that includes a medical history. He or she will ask you detailed questions about your foot injury, such as how and when did the pain start, what type of discomfort do you feel, and what activity caused your injury. In addition, your physiotherapist will perform tests on your body to find physical problems, such as the following:

  • Joint stiffness
  • Misalignment of the cuboid bone.
  • Weakness or tightness in the muscles.

If a more severe problem is suspected or discovered, your physiotherapist may collaborate with a physician to obtain additional diagnostic testing, such as an X-ray.

After a diagnosis has been done, your physiotherapist will work with you to design a specific treatment plan that will help boost your recovery, including exercises and treatments that you can try at home. Your physiotherapist will work with you with the following treatment plans:

  • Reduce pain and other symptoms – Your physiotherapist will help you understand how to avoid or modify the activities that caused the injury. He or she may also use different types of treatments and technologies to control and reduce your pain and symptoms. The focus will be placed on physiotherapy, icing, and gentle movement to reduce pain without the need for any pain medication.
  • Improve your flexibility – Your physiotherapist will determine if any muscles in the area are tight, start helping you stretch them, and teach you stretching exercises to perform at home.
  • Improve your motion – Your physiotherapist will choose specific activities and treatments to help restore normal movement in the foot or in any stiff joints. Certain treatments might start with passive motions that your therapist performs for you to move a joint, and progress to active exercises and stretches that you can do yourself.
  • Improve your strength – If your physiotherapist finds any weak muscles, your therapist will choose and teach you the correct exercises to slowly restore your strength and agility. When addressing cuboid syndrome, foot and ankle muscle exercises are often taught to help strengthen the muscles and tendons around the cuboid bone.
  • Improve your endurance – Restoring endurance is important after an injury – your physiotherapist will develop a group of activities to help you regain the endurance you had before the injury.
  • Home programs – Your physiotherapist will teach you strengthening, stretching, and pain-reduction exercises to perform at home. These exercises will be specific for your recovery process.
  • Return to your activities – Your physiotherapist will discuss your activity levels with you and use them to set your work, sport, and homeopathic recovery goals.

If the cuboid syndrome worsens, your physiotherapist can perform foot manipulations to help, including:

  • Cuboid squeeze – Lie with your leg relaxed and off the edge of a table, while your therapist holds the foot, flexes it, and pushes on the cuboid from the top of the foot.
  • Cuboid whip – Lie on your back with your knee of the injured foot bent, while your physiotherapist holds the injured foot. Next, straighten your knee quickly with the foot flexed. Your therapist will push forcefully on the cuboid bone from the bottom of the foot to pop it back into place.

Here are several other exercises you can try yourself to help recover and improve symptoms linked to cuboid syndrome:

 

Seated toe towel scrunches

Begin by sitting upright in a chair with one foot resting on a towel and spreading your toes. Then, curl your toes to scrunch and draw the towel toward you 10 times. Perform 2 sets per foot, once a day.

Sitting ankle inversion

Sit upright on the floor with your legs straight out in front of you. Next, place your left leg over your right leg with a resistance band secured around your upper foot and looped around the bottom of your lower foot. Hold the end of a resistance band in your hand, then slowly move your upper foot away from the lower foot. Repeat this method 10 times a day.

Wall-facing calf stretch

Stand upright facing a wall at arm’s length and place your hands flat on the wall. Keeping both feet flat on the floor, extend one leg straight backward, bending your front leg until you feel a stretch in the calf of your back leg. Hold for 20 seconds and repeat 3 times a day.

Alternative & Homeopathic Treatment

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Homeopathic treatment of cuboid syndrome involves the RICE method, which stands for the rest, ice application, compression, and elevation of the affected foot. Home treatments for cuboid bone pain include:

  • Rest – Rest prevents excessive stress on the foot bones and helps the body to heal the injured connective tissues surrounding the cuboid bone.
  • Ice application – The application of ice compressions to the affected foot can help reduce swelling, inflammation, and pain. Place a thin towel over the foot and apply ice cold compressions to the mid part of the outer foot. Keep it for 5-6 minutes at a time then remove and repeat for three times a day.
  • Compression bandage – Compression bandages can be used to minimize movement of the foot.
  • Orthotics – Orthotics provide support to the foot and can be worn inside of the shoe. Orthotics can be helpful for proper alignment of foot bones and reduce overpronation of the foot.
  • Taping and padding – Taping is useful to stabilize the cuboid bone and allows soft tissues to recover by minimizing movement of your ankle and foot.