syndrome refers to the disruption of the normal function of the calcaneal-cuboid
joint (CC joint). Disruption of the CC joint is often called subluxation. Cuboid
syndrome is somewhat obscure and poorly defined in the literature. When
conditions are poorly defined in the literature, this means that there
is a lack of consensus among doctors as to the etiology (reason for the
condition) and the treatment. Cuboid syndrome can also be found in the
literature described as a sequella of inversion sprains of the ankle.
Cuboid syndrome can also describe a sprain of the CC joint or any of the
supporting structure contiguous to the CC joint. These structures include
the calcaneo-cuboid ligaments and peroneus longus tendon.
The onset of cuboid syndrome varies and can be abrupt (most common) or
insidious in onset. Pain is typically site specific to the plantar lateral
cuboid. Indurated (hard) edema may be found. Bruising is uncommon.
The diagnosis of cuboid syndrome is made based upon the location and onset of
pain. Plain x-ray should be used to differentiate cuboid syndrome from
fractures. MRI is also helpful to define soft tissue problems that occur in the region
of the CC joint (see differential diagnosis below).
Treatment Of Cuboid Syndrome
Cuboid syndrome, when due to subluxation of the calcaneal-cuboid joint, is treated by reducing (realigning) the subluxation of the CC
joint and stabilizing the reduction. It is believe by many, but not all
practitioners that reduction of the subluxation can be
accomplished by manipulating the joint. Manipulation is performed with the
patient in a prone (face down) position. The doctor cradles the foot in
his/her hands and places both thumbs beneath the CC joint. The CC joint is
then manipulated by a forceful movement, moving the leg at the knee and the
ankle while applying pressure with the thumbs at the plantar (bottom) aspect of
the CC joint. This procedure is called a cuboid whip.
Reduction of the subluxation can be maintained with taping and
padding. Padding of the lateral sole is used to maintain the reduction of the
CC joint and limit supination (rolling to the outside of the foot).
Lateral sole wedges
can be placed in the shoe or applied to the outer sole of the shoe at a shoe
repair shop. Rest, ice, compression and elevation (RICE) is used as a
treatment of cuboid syndrome. The use of oral NSAID medications is also
common. Occasionally, cortisone injections may be
helpful in reducing inflammation associated with the subluxation of the CC
joint. Patients are instructed to avoid going barefoot or wearing shoes
with low heels.
Heel lifts worn within the shoe can also be
Once the acute symptoms are resolved, prescription orthotics (arch supports)
are helpful in preventing a recurrence of cuboid syndrome.
The response to treatment of cuboid syndrome depends upon the etiology and
onset of symptoms. Acute onset of cuboid syndrome, say from an ankle
sprain, may respond dramatically to manipulation. If cuboid syndrome is
due to chronic, excessive intrinsic load (CT Band Syndrome) treatment such as
manipulation may be less effective and take longer to see results.
A bone of the lateral midfoot named after its square shape. The cuboid has historically been
used in games as a dice.
Chopart's Joint -
Includes the talo-navicular joint and the calcaneal-cuboid
joint. Named after the French surgeon Francois Chopart (1743-1795).
CT Band - 'calf to toes' band. Describes a band consisting of the calf,
Achilles tendon, ankle and plantar fascia.
Extrinsic load - any load delivered to the foot that is exclusive of
intrinsic load. Extrinsic load includes load applied to the lower extremity by
proximal muscle transfer or by upper extremity torsion.
Intrinsic load - Load applied to the foot through the CT band.
Subluxation - Motion of a joint that is irregular and not in alignment with the
normal range of motion of the joint.
Tarsal bone - the large bones of the rear foot including the calcaneus, talus,
navicular and cuboid.
Tarsitis - Chronic inflammation and pain of the tarsal bones.
The calcaneal-cuboid joint (CC joint) is located on the lateral (outside)
aspect of the foot. The CC joint can be found immediately below the
outside of the ankle and about two fingers distal (towards the toes). The
CC joint is a broad, flat joint build to bear load. The joint has very
little movement or motion. The CC joint is surrounded by a number of stout
ligaments that are intended to limit motion and stabilize the joint. On
the plantar aspect (bottom) of the joint are the long plantar ligament and
calcaneal-cuboid ligament. The lateral side (outside) of the joint is
stabilized by the dorsal calcaneal-cuboid ligament. The dorsal aspect
(top) of the cuboid is stabilized by the dorsal cuneo-cuboid ligament, the
tarso-metatarsal ligaments, dorsal cuboideo-navicular ligament and miscellaneous
The CC joint is also stabilized by a number of contiguous structures that
pass above, below or along the cuboid. The most significant of these is
the peroneus longus tendon that wraps along the lateral and plantar aspects of
the cuboid. The cuboid is essentially help in a sling by the peroneus
longus tendon. Other structures include the peroneus brevis tendon, dorsal
and plantar musculature and retinaculum.
Cuboid syndrome occurs at the calcaneal-cuboid joint (CC joint) on the
lateral or outside of the foot. The CC joint functions together with
the talo-navicular joint (TN joint) and the subtalar joint (STJ) to deliver load
to the forefoot. The function of these joints is to deliver load that can
be converted into action; walking, running etc. For additional definitions
of load in relationship to the normal function of the foot and leg, please refer
to our article on
CT band syndrome.
Cuboid syndrome occurs when the calcaneal-cuboid joint is unable to carry the
load that is applied to it. The calcaneal-cuboid joint is part of what's
referred to as the lateral column of the foot. The lateral column is the
primary load bearing section of the foot that transfers load from the heel to
the forefoot following the heel strike phase of gait. The result is that the calcaneal-cuboid joint subluxes (moves out of its' normal position).
The onset of cuboid syndrome may be due to an acute injury of the lower
extremity such as an inversion sprain of the ankle. Occasionally the
symptoms of cuboid syndrome occur without an obvious injury. The symptoms
of cuboid syndrome are very similar to the symptoms of a sprain. Pain is
significant when weight is first applied to the foot. Pain increases with
the toe off phase of gait as the weight of the body and load from the calf
muscle are delivered to the lateral (outside) column of the foot.
Calcaneal stress fracture
Compression neuropathy of the sural nerve
Partial peroneal tendon rupture
5th metatarsal avulsion fracture
Sinus tarsi syndrome
Products Recommended for Cuboid Syndrome:
This article was written by Jeffrey A. Oster, DPM and last updated 2/5/13.
1. Stone DA, Kamenski R, Shaw J, Nachazel KMJ, Conti SF, Fu FH. Sports
Injuries, Mechanics, Prevention, Treatment-Second Edition. Philadelphia,
Lippincott Williams and Wilkin; 2001. pp381-397.
2. Leerar, PJ. Differential Diagnosis of Tarsal Coalition versus Cuboid Syndrome
In An Adolescent Athlete. J Orthop Sports Phys Ther 2001; 31(12)
3. Marshall P, Hamilton WG. Cuboid Subluxation In Ballet Dancers. Am J Sport Med
4. Mooney M, Maffey-Ward L. Cuboid Plantar And Dorsal Subluxations: Assesment
And Treatment. J Ortho Sports Phys Ther 1994; 20(4).
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