Recognizing Cuboid Syndrome

Cuboid syndrome is an underappreciated cause of lateral midfoot pain. It is theorized to arise from a disruption of calcaneocuboid joint integrity because of recurrent or forceful eversion of the cuboid, potentially resulting in an impinged or displaced calcaneocuboid labrum (1). The syndrome often presents with swelling, lateral proximal foot pain, and antalgic gait (2). There are no reliable imaging modalities for identifying this condition, and diagnosis is often made on the basis of history, mechanism of injury, and clinical examination. Common mechanisms of injury include: Levering the lateral foot across a protrusion in the ground while running (e.g., stepping on a tree root while trail running or on a prominent crack while road running). Lateral ankle sprains. PEARL: This can be a cause of persistent pain following an ankle sprain that is not responsive to standard treatments. Peroneal tendinopathy. Overuse of the peroneal tendons may cause recurrent cuboid eversion, particularly in those with pronated feet (3). There are two physical examination maneuvers which may elicit pain from a person with cuboid syndrome and thus aid in diagnosis: The midtarsal adduction test: the adduction test is performed by adducting the midtarsal joint in the transverse plane while stabilizing the calcaneus. The midtarsal supination test (1): the supination test is performed similarly, however, the foot is inverted and plantarflexed.