How To Treat Cuboid Syndrome In The Athlete

Author(s): 
By Mark A. Caselli, DPM, and Nikiforos Pantelaras, DPM

Pertinent Pearls For Treating Cuboid Subluxation
Once one has diagnosed cuboid syndrome, reducing the subluxed cuboid is the first step in the treatment process. Clinicians may employ a manipulative technique, which is often defined as a low-amplitude, high-velocity mobilization at the end of joint range, to restore proper joint congruency. However, be aware that there are contraindications to this manipulation technique. The contraindications include neoplastic or bone disease, inflammatory arthritis, gout and neural or vascular abnormalities.

While facing the plantar surface of the patient’s foot, place your thumbs on the medial plantar surface of the cuboid with your fingers on the dorsal side. Doing so stabilizes the forefoot. Take care not to place the fingers directly over the cuboid on the dorsal side. Keeping the ankle joint in slight plantarflexion, apply a dorsally directed force to the medial side of the cuboid with a small amplitude, high-velocity thrust (see the photo at left). Often, the athlete experiences complete relief of symptoms with a successful reduction.
One can then apply ice to the lateral side of the foot to reduce any inflammatory response and pain if necessary. Afterward, clinicians should use a cuboid pad in conjunction with a low-dye taping to maintain the cuboid reduction and give the arch added support.
The cuboid pad is usually made of 1/4 inch felt. It is approximately 1.5 inches wide and 2 to 3 inches long. Ensure that the pad is skived at the edges for better fit and comfort. One can determine the actual length of the pad by measuring the distance from the calcaneocuboid articulation to the cuboid-fifth metatarsal articulation.
Place the pad directly under the cuboid bone. It should not extend distally under the styloid process of the fifth metatarsal. Keep in mind that the cuboid pad may at times spontaneously adjust a mildly subluxed cuboid by its upward thrust.
Further follow-up treatment may consist of placing a cuboid pad in the shoe, attaching one to a removable innersole or incorporating one into a foot orthosis. When placing this pad on a flexible orthosis, such as a leather laminate type of orthosis, you can place it on the bottom of the device. If the patient uses a more rigid orthosis, place the pad on the top.
At this time, one should address other biomechanical abnormalities, such as a limb length discrepancy or ankle equinus. Patients may gradually return to sports activity when the pain subsides.

Final Notes
Keep in mind that cuboid subluxation following a second-degree or third-degree lateral foot sprain requires special care in order to prevent the development of a chronic condition. If one suspects a cuboid subluxation after a lateral foot sprain, do not attempt reduction until the effusion and ecchymosis have significantly diminished and you have ruled out the possibility of a fracture.
When athletes present with ankle inversion sprains and complain of lateral foot pain, one should evaluate their cuboid articulations.
Appropriate assessment and treatment of a subluxed cuboid is essential in order to restore normal joint range of motion, alleviate pain and improve foot function.

Dr. Caselli (pictured) is a staff podiatrist at the VA Hudson Valley Health Care System in Montrose, N.Y. He is also an Adjunct Professor at the New York College of Podiatric Medicine and a Fellow of the American College of Sports Medicine.

Dr. Pantelaras is a podiatric orthopedic resident at the VA Hudson Valley Health Care System in Montrose, N.Y.




References:

References

1. Caselli MA. Is peroneal spastic flatfoot causing chronic ankle pain? Podiatry Today 2002; 15(6).

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 Sports Med 1992; 20(2).

4. Mooney M, Maffey-Ward L. Cuboid plantar and dorsal subluxations: assessment and treatment. J Ortho Sports Phys Ther 1994; 20(4).

5. Stone DA, Kamenski R, Shaw J, Nachazel KMJ, Conti SF, Fu FH. Dance. In Fu FH, Stone DA (eds). Sports Injuries, Mechanics, Prevention, Treatment-Second Edition. Philadelphia, Lippincott Williams & Wilkins; 2001. pp 381-397.

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