From the Guidelines
Cuboid syndrome should be initially evaluated with MRI to detect radiographically occult fractures and assess the extent of injury, as it allows visualization of bone marrow edema patterns and optimal visualization of the bone marrow within accessory ossicles 1. When diagnosing cuboid syndrome, it is essential to consider the patient's symptoms and medical history. The condition is characterized by pain on the lateral side of the foot, typically resulting from injury or displacement of the cuboid bone.
- Key diagnostic considerations include:
- MRI to detect radiographically occult fractures, as demonstrated by Pierre-Jerome et al, who found 79% of cuboid fractures in the diabetic population were radiographically occult using MRI 1.
- Ultrasound (US) as an alternative imaging modality, which can detect cortical irregularities and soft-tissue injury in the acute or subacute setting, as shown by Wang et al 1. Treatment for cuboid syndrome typically involves a combination of conservative management and physical therapy.
- Initial management includes:
- Rest, ice, compression, and elevation (RICE protocol) to reduce initial pain and inflammation.
- Non-steroidal anti-inflammatory drugs like ibuprofen (400-600mg three times daily with food) to manage pain.
- Physical therapy is crucial, focusing on cuboid manipulation techniques, where a trained therapist applies pressure to realign the displaced bone.
- Self-management strategies include:
- Foot taping for support.
- Wearing proper footwear with good arch support.
- Gradually performing foot strengthening exercises, such as toe curls and ankle circles.
- Orthotic inserts may provide additional support, as they can help reduce stress on the cuboid bone and promote proper foot alignment. It is essential to note that most cases of cuboid syndrome resolve within 2-6 weeks with proper treatment. However, if pain persists beyond several weeks despite treatment, further medical evaluation may be necessary to rule out other conditions like stress fractures or peroneal tendonitis.
From the Research
Definition and Diagnosis of Cuboid Syndrome
- Cuboid syndrome is a poorly understood condition that is difficult to recognize and is commonly misdiagnosed 2
- The diagnosis is largely based on the patient's history and a collection of signs and symptoms associated with the condition, as radiographic imaging is of little value 2
- The symptoms of cuboid syndrome resemble those of a ligament sprain, and there are no definitive diagnostic tests for this condition 3
- A high index of suspicion and a constellation of signs and symptoms are often used to diagnose cuboid syndrome 3
Causes and Treatment of Cuboid Syndrome
- Cuboid syndrome is thought to arise from subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid joint 3
- The precise pathomechanic mechanism of cuboid syndrome has not been elucidated, but fibroadipose synovial folds within the calcaneocuboid joint may play a role in the cause of the syndrome 3
- Cuboid syndrome responds exceptionally well to conservative treatment involving specific cuboid manipulation techniques 2, 4
- Other methods of conservative treatment, including therapeutic modalities, therapeutic exercises, padding, and low dye taping techniques, are used as adjuncts in the treatment of cuboid syndrome 2
- Manipulation of the cuboid should be considered as an initial treatment, unless contraindicated 3
Patient Outcomes and Prognosis
- Once properly diagnosed, cuboid syndrome responds well to treatment, and the prognosis is excellent 2
- Patients who are properly diagnosed with cuboid syndrome and receive cuboid manipulation can return to competitive activity within 1 or 2 visits without injury recurrence 4
- The patient may note a decrease or a complete cessation of their symptoms immediately after the manipulation is performed 2