Cuboid Syndrome
Introduction[edit | edit source]
Cuboid syndrome is an easily misdiagnosed source of lateral midfoot pain, and is believed to arise from a subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid(CC) joint, which in turn irritates the joint capsule, ligaments, and fibularis (peroneus) longus tendon.[1]Cuboid syndrome has been documented in the podiatric, orthopaedic, osteopathic, and physical therapy literature under various terms, including subluxed cuboid, locked cuboid, Dropped cuboid, cuboid fault syndrome, and lateral plantar neuritis.Because of the nature and inconsistent terminology associated with this injury, cuboid syndrome remains a poorly understood condition in both athletic and non-athletic populations,therefore it is a often mistreated and misdiagnosed condition.[1]
Cuboid syndrome represents approximately 4% of all foot injuries.[2]cuboid syndrome is present approximately 7% following plantar-flexion and inversion ankle sprains.[3] It appears that the occurrence of cuboid syndrome in professional ballet dancers may be higher, accounting for up to 17% of reported foot and ankle injuries in this population.[4]
Clinically Relevant Anatomy[edit | edit source]
The cuboid is a pyramid-shaped, short bone on the lateral aspect of the foot with 6 surfaces. It articulates anteriorly with the fourth and fifth metatarsal bases, medially with the lateral cuneiform and navicular, and posteriorly with the calcaneus.CC joint function is dependent on midtarsal joint mechanics, since the navicular and cuboid bones move essentially in tandem during gait.[5] The mechanics of the CC joint are highly variable.[6] The principal movement at the CC joint is medial/ lateral rotation about an anterior/posterior axis with the calcaneal process acting as a pivot.The cuboid rotates as much as 25° during inversion/eversion about an axis that passes from posteroinferior to anterosuperior at an angle of roughly 52° (range, 43°-72°) with respect to the ground.In addition to inversion/eversion, there is some evidence that posterior-anterior distraction of the CC joint also occurs during the gait cycle.[7]
The CC joint is intrinsically stable due to the congruence of its articular surfaces and reinforcement from ligaments and tendon attachments.The CC joint appears to be maximally congruent radiographically when the calcaneus is placed in a vertical position.The dorsal and plantar cuboideonavicular and cuboideometatarsal ligaments and wedge-shaped fibroadipose labra within the CC joint and cuboid-metatarsal joints contribute to stability.The peroneus longus tendon, which forms a sling around the lateral and plantar aspects of the cuboid before inserting on the plantar aspect of the lateral first metatarsal base and medial cuneiform, also assists with CC joint stabilization. The cuboid is a pulley for the peroneus longus tendon; muscle contraction from midstance through the late propulsive phase exerts an eversion torque on the cuboid. Eversion of the cuboid via the peroneus longus tendon is thought to facilitate load transfer across the forefoot from lateral to medial as stance progresses[8][1].
Mechanism of Injury / Pathological Process
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There are two proposed mechanisms of injury:
- Plantar-flexion and Inversion Injuries: During rapid Plantar flexion and Inversion (i.e. mechanism of lateral ankle sprain) there is a strong reflex contraction of the peroneus longus muscle.During this forceful contraction the cuboid acts as a fulcrum, and the tendon then applies a force on the cuboid causing infero-medial displacement i.e. cuboid subluxation.[9]
- Overuse Syndrome: This is uncommonly described and rarely seen but it is suggested that subluxation of the cuboid occurs secondary to repeated microtrauma secondary to vigourous activities.[4]
Predisposing Factors
- Midtarsal instability
- Excessive body weight
- Ill-fitting or poorly constructed orthoses or shoes
- Exercise (ie, intensity, duration, frequency)
- Training on uneven surfaces
- Sprain of the foot or ankle
- Cuboid syndrome may be more prevalent in individuals with pronated feet due to the increased moment arm of the peroneus longus.[1]
Clinical Presentation[edit | edit source]
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Diagnostic Procedures[edit | edit source]
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Outcome Measures[edit | edit source]
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Management / Interventions
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Differential Diagnosis
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Resources
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References[edit | edit source]
- ↑ 1.0 1.1 1.2 1.3 Blakeslee TJ, Morris JL. Cuboid syndrome and the significance of midtarsal joint stability. Journal of the American Podiatric Medical Association. 1987 Dec;77(12):638-42.
- ↑ Newell SG, Woodle A. Cuboid syndrome. The Physician and sportsmedicine. 1981 Apr 1;9(4):71-6.
- ↑ Jennings J, Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. Journal of orthopaedic & sports physical therapy. 2005 Jul;35(7):409-15.
- ↑ 4.0 4.1 Marshall P, Hamilton WG. Cuboid subluxation in ballet dancers. The american journal of sports medicine. 1992 Mar;20(2):169-75.
- ↑ Hardy RH. Observations on the structure and properties of the plantar calcaneo-navicular ligament in man. Journal of anatomy. 1951 Apr;85(Pt 2):135.
- ↑ Nester CJ, Findlow AH. Clinical and experimental models of the midtarsal joint: proposed terms of reference and associated terminology. Journal of the American Podiatric Medical Association. 2006 Jan;96(1):24-31.
- ↑ Greiner TM, Ball KA. The calcaneocuboid joint moves with three degrees of freedom. Journal of foot and ankle research. 2008 Sep;1(1):O39.
- ↑ Bojsen-Møller FI. Calcaneocuboid joint and stability of the longitudinal arch of the foot at high and low gear push off. Journal of Anatomy. 1979 Aug;129(Pt 1):165.
- ↑ Patterson SM. Cuboid syndrome: a review of the literature. Journal of sports science & medicine. 2006 Dec;5(4):597.
