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Cuboid Syndrome

Cuboid syndrome is thought to be a poorly diagnosed condition where the cuboid subluxates causing discomfort, pain and reduction in foot function usually as a result of poor biomechanics and in the case of ballet dancers repetitive exercises placing strain on various joints of the foot with associated ligamentous laxity. If diagnosed promptly, reduction may be performed by a technique called the "cuboid squeeze" or "cuboid whip" which should minimise any pain associated with the condition. Preventative measures should also play a part of therapy such as orthotics and strapping.
 
 It is thought that as much as 80% of cuboid subluxations, especially in athletes, occur in a pronated foot, muscles are also thought to be involved in the subluxation process. The patient will commonly complain of lateral foot pain and weakness in the toe off or push off stage of the gait cycle. Often, the pain may radiate to the plantar aspect of the medial longitudinal arch, as well as the anterior ankle joint, or sometimes distally along the fourth metatarsal. With athletes, such as ballet dancers, vigorous dancing and jumping are not normally possible due to very sharp and localised pain. Palpation of the cuboid in a dorsal direction may also elicit painful sensations In the case of severely subluxated cuboids, a slight depression may be visible on the dorsum of the cuboid and a lump on the plantar surface  Cuboid subluxations are difficult to diagnose in terms of radiographs and other investigations such as CT scans,  and MRI scans  The dislocation or subluxation of the fourth metatarsal may be mistaken for a cuboid subluxation. This is due to the fact that the head of the fourth metatarsal will be plantarflexed in relation to the other metatarsal heads, when the head of the fourth metatarsal subluxates dorsally on the cuboid. Similar symptoms to cuboid subluxations are experienced by the patient, increasing the likelihood of misdiagnosis. Cuboid subluxations may also occur secondary to a lateral ankle sprain. They are, however, more difficult to detect since there is associated soft tissue swelling with marked effusion and ecchymosis. This makes viewing the shallow depression described previously quite difficult or impossible. By palpating the cuboid and pressing it in a dorsal direction, significant pain will be experienced by a patient who has had an ankle sprain as well as a cuboid subluxation. A patient with only an ankle sprain will experience some discomfort but not the severe pain accompanying a cuboid subluxation. Other features to look for include continuing symptoms including inability to move or use the foot, especially for extended periods of time
A successful reduction is usually followed by an audible sound, although this does not occur 100% of the time. With regards to cases less than a day old, the reduction will almost always produce an instantaneous and total reduction of symptoms ie. reduce pain and restore function. Subluxation which have remained for longer than a day may not have their symptoms immediately reduced following a successful reduction and residual discomfort may follow for a few days This is of course, dependant upon the severity of the injury.

 

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Page last updated 14 October, 2007