Ankle Sprain? No, It's Cuboid Syndrome

R cuboid bone in the foot

I had a patient who came to our clinic today complaining of pain in the outside of his left foot. He thought he had sprained his ankle about 3 weeks ago while playing football barefoot. He rested, iced it  etc but it did not seem to get a lot better.

He then went to a Sports Doctor who diagnosed him with an ankle sprain and suggested that he see a Physiotherapist, which he did, but the one he saw did not make his ankle any better.

He still had most discomfort/ pain on the outer part of his left foot/ankle. Pain was worse during the push off phase of walking. He also couldn't run properly without pain.

However, his ankle proprioception (or joint position sense) was also not affected. Usually for ankle sprains, a patient's proprioception is usually worse on the affected side.

After a thorough assessment I found his ankle joint to be stable and free of pain. His pain increased on firm palpation of his left cuboid bone. The left cuboid also was sitting in a lower position compared to his right foot.

I explained to him that he did not sprain his ankle but instead there was probably a subluxation (or mild dislocation) in his cuboid bone. (I had actually seen two other cases of cuboid syndrome in the last few months).

The cuboid bone sits at the outer aspect of the mid foot and his connected to adjacent bones by strong connective tissue and ligaments (see picture above). During certain weight bearing activities like running, excessive forces placed on the cuboid bone (from the peroneal longus muscle especially) can sublux (or dislocate) the cuboid bone. This is exactly what happened to my patient. I've also seen this condition fairly frequently in ballet dancers that I've treated before.

How did I treat my patient? After the diagnosis, this is the easy part, or so I thought. I got him to lie on his tummy and gently tried to coax (or mobilise) his cuboid back into where it should be sitting. For some strange reason, it took a lot longer than I expected. My last two patients with cuboid syndromes had their cuboids back into position in less than five minutes.

It took me almost 20 minutes before my patient, his mother and I heard a loud click (of course I felt it with my hands too) suggesting I had relocated the bone.

I got my patient to stand up and try and he gave me a big smile after trying to walk and run. Job done, next patient waiting .....

Have a look at the reference below if you want to know more about cuboid syndrome.

Reference

Durall CJ (2011). Examination And Treatment Of Cuboid Syndrome. A Literature Review. Sports Health. 3(6): 514-519. DOI: 10.1177/1941738111405965.