Since choosing to focus most of my practice on foot and ankle injuries, I have since realised that cuboid syndrome is not only a real phenomenon, but that the cuboid bone and its subsequent dysfunction can cause a host of issues.
This article will summarise just some of the implications of having a cuboid that is not functioning as well as possible in the hope more clinicians will pick them up and sort them out.
The cuboid can dislocate, most commonly in a plantar direction, and is described in a variety of articles and textbooks, mostly in ballet dancers. There are case reports of runners having their cuboid dislocate and these almost always involve high speed movement and rotation or change of direction, which in turn causes a force that twists the cuboid out of optimal alignment. It would stand to reason that if the bone can dislocate, then it is not a far leap of faith to accept the cuboid can sublux.
If we can accept that all synovial joints function best when the articular surfaces are in optimal alignment, anything that disrupts this is likely to cause issues, both locally and up or down the kinetic chain.
My most recent clinical example was a middle age female distance runner who had been unable to run more than 3km for 3 years due to lateral foot pain. MRI revealed degenerative changes at the calcaneo-cuboid joint and clinical assessment revealed a clearly dysfunctional cuboid.
Further to this, the runner had developed lateral hip pain, which was diagnosed as gluteus medius tendinopathy and trochanteric bursitis. Initial treatment involved mobilisation and manipulation of the cuboid. There are fantastic You Tube videos demonstrating this treatment and I would encourage you all to take a look.
After two sessions of foot manipulation, mobilisation, strengthening the local area and applying a hip tendinopathy treatment approach, she was back walk:running for 30 minutes without pain. Each time she returned for subsequent progressions, her cuboid needed manipulating each and every time. Closer inspection of her strategy for single leg standing and the way she completed her gluteus medius hip hitch exercise revealed some fascinating observation. As the runner moved her weight laterally, her foot supinated and supported her weight more laterally. There was little or no 1st ray contact. A simple cue and change of foot position and at next review, she was back to running 5km pain free, 3 x week. Her cuboid assessment was normal for the first time in 4 months!
This one case study demonstrates just how critical foot function can be for the rest of the body and there are countless other examples within the literature. Another great example is this recent case report by Patla, Lwin, Smith and Chaconas (2015) – https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4458924/pdf/ijspt-06-363.pdf
So to anyone presenting with any foot or ankle pain, make sure the cuboid is checked. In fact I now check the cuboid with any client presenting with any lateral pain, such as ITB, lateral hip or even unilateral lower back issues. After all as the song goes … “the hip bone is connected to the knee bone……” Happy hunting for those cursed cuboids.
Written by Andrew Wynd