Cuboid syndrome?

[t.delacour]

I am a high school cross country runner, and coming to the climax of the season, I have been training harder than usual. At my latest meet I began experiencing pain on the lateral side of my foot approximately 45 minutes before my race, however the pain disappeared when the gun went off, I presume due to adrenaline. After finishing, I found that walking became increasingly difficult the more I stayed on my feet. When I got home I found significant visible inflammation and some bruising. Based off of online research I have concluded that my symptoms most closely match Cuboid Syndrome. These symptoms include a pain on the lateral side of my foot, in front of the heel, but behind the fifth metatarsal, occurring during the push off stage of my stride. I can eliminate almost all the pain by walking on my toes. After resting (sitting or lying down) for a while, I am able to walk pain free for an amount of time (the longer the rest, the longer this lasts), however the pain slowly comes back until it reduces me to a limp. I do remember remarking, when I first felt the pain, that it sort of felt like something was shifted out of place in my foot, and that if I stomped down really hard on a curb it would feel better (speculation only, for I did not try it). I also feel a faint, high frequency vibration, right where I suspect the tendon goes around the Cuboid, when I stretch my foot in the direction which makes it parallel to my tibia. I have eliminated the inflammation through icing and rest. I am currently low dye taping my foot, however if I remove the tape and begin walking, the pain returns within minutes (I also experience pain with the tape, although less of it). Three full days have passed and I see no noticeable improvement other than the lack of visible inflammation (although that was practically eliminated within 24 hours of the injury). After that long winded explanation, I have two questions. Is there a likely competing diagnosis for the listed symptoms? If it is Cuboid Syndrome, will the bone right itself over time, or is a doctor needed? I have a very important (regionals) meet in 10 days, so the second question comes with an asterisk in the sense that I cannot wait very long. Besides, I am antsy to resume training.

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[SigMik]

Dear t.delacour,

it sounds like you've done excellent in diagnosing yourself... I can personally not see any symptoms of which you describe, that don't fit with the diagnosis of cuboid syndrome. My main references for this is localized and visible signs of inflammation, pain at push off in stride, a sensation of something being shifted. The faint, high frequency vibration (excellent description by the way!) could potentially represent some involvement of the sural nerve... The only thing that surprises me is that you can eliminate almost all pain by walking on toes... But, no injury behaves the same... I'd say you're correct.

It is worth a try to get the cuboid bone mobilized or manipulated. You'll probably find a youtube video called something like cuboid whip or cuboid manipulation. They usually respond pretty well when successful, successful more dependent on your particular injury rather than the technique I'd suggest... A physio, chiro or osteopath could help you with this. Or even try to mobilize it yourself and see how it responds. If it responds, I usually see a lot of improvement within first session, if not better after two sessions, then try something else.

Cuboid syndromes also usually responds very well to conservative management (move within pain/adapt activities/rest/treatment) and will not heal faster if you see a doctor. If you'll run in 10 days? My general take on this would be that you're likely to exacerbate it, and potentially have a longer time of recovery after that run, than if you rested. But, I find it very difficult to give a meaningful prognosis on this without really seeing you. Hope this answers some of the questions you had, and maybe some of the other therapists in here will skip in with some helpful comments as well. Good luck with your recovery anyway!

Kind regards,
Sigurd Mikkelsen

[t.delacour]

Thank you very much, I shall look into manipulation techniques.

[alophysio]

Hi t.delacour - SigMik makes very good points. It is very hard to diagnose people on the internet...

My point about your condition will be "Why"? Why did it "go" 45mins before a race? Had you already warmed up? Was it a muscle or tendon that pulled? A ligament sprain? Overloading coming to a head? Perhaps it was the sural nerve as SigMik suggested.

But all of that doesn't help your pain.

I actually don't think you cuboid syndrome/subluxation because if the joint was actually "out" or jammed or stuck etc, then walking on your toes would be painful+++. I have personally had this. And i have fixed lots of them in my time over the years...The results are usually immediate with 70+% dec in pain immediately with resolution of pain within a few days...but a soft tissue sprain will take up to 6 weeks or more to heal properly so your foot will be "weak" or vulnerable until the 6 weeks is up.

You more than likely have a muscle/tendon "misfiring" pulling on the foot joints.

Again hard to tell without seeing it in person.

Hope that helps

[t.delacour]

Actually the 'why' is somewhat hazy, and is one aspect which does not seem to correspond to any dislocation of sorts. I cannot recall one instant in which my foot suddenly 'went', but it also was definitely not a gradual onset either. All I remember is sitting on a grassy hill, getting up and sort of realizing that it hurt. This was shortly after my course walk, and just prior to warming up. Could it be possible that overuse had put my foot on the verge of the injury, and getting up quickly was the 'feather that broke the camels back' as they say? What exactly would a tendon 'misfiring' be? Is there a medical term for it? How is it treated?

[alophysio]

Hi - if i were to guess - and i am only guessing - you were sitting on the hill with your foot tucked under a bit - like pointing your toes and pointed in - corss legged sitting, sitting in "mermaid pos" or your feet tucked to one side etc. If not, then i am not sure but twisting your foot like that for a while can cause "creep" in the tissues which stretches them too far and then you can get issues.

You should really be seeing someone about it. Like we said - it would only be once or twice. What is the price of 2 sessions of physio compared to missing out on regionals?

[t.delacour]

Yes, that was how I was sitting. In regard to the injury, however, I have seen a dramatic change (for the best) in the past 24 hours. I had my dad do some of the manipulations on my foot; I can't say for sure whether or not that is what helped, but either way I can walk comfortably now, and feel only a very slight, dull remnant of pain. I will continue to tape, rest, etc, but otherwise it seems well on its way to being over. Thanks for all the advice!

[SigMik]

Hi again, t. delacour.

I'm extremely pleased to hear that you've had a good improvement the last 24 hours! Maybe you're dad got unknown physio-talents! If it wouldn't be too much to ask, would you mind giving us a small report on how you feel in about 12 days time? Just to hear how your foot responds towards the regionals and if you'll give it a go. Good luck anyway!

[t.delacour]

Hi again, So I ran regionals yesterday: we didn't make states, but the ankle deep mud across the coarse made it worth it anyways. I did not feel my foot hurting at all that day or during the race, however it felt like the problem had come back about 30 minutes after I finished. This morning it feels fine though, and since the season is over I have a few weeks to rest it before track. Thanks again for all the help

[alophysio]

Thanks for the update. All the best for track season. Cheers

[lazerpixie]

I know this thread is pretty old, but I just thought I'd post because I am experiencing the exact same problem. I've been searching for others with this problem for days and this is the first post I've come across that describes what I'm experiencing pretty much to a T, the only exception beingr the "vibrations".

Pain started in the exact same region the OP describes after 3-4 days of no running. One morning walking to the bus I just noticed this pain on the outside of my foot, attributed it to uncomfortable boots and found that it got progressively worse over the next two days. Walking on my toes eliminates the pain 99% of the time and when I run after the initial bit of tenderness as I warm up and start to lean forward/land on the forefoot the pain goes away completely. After running I feel no pain for some time and then it gradually starts to creep in again. Also, just like with the OP, after staying still/sitting/not walking for a while and then getting up I feel no pain for the first several minutes (the longer the rest, the slower it comes on).

I saw a physiotherapist about this a few days ago and he diagnosed cuboid syndrome, performed some manipulation techniques and taped up the foot. The pain is now not as bad as it was before (before I was literally hobbling and had to stay on my toes with that one foot to be able to walk). Now it's definitely still there, but at least I'm not limping anymore. However, it's been at this stage for a couple of days and doesn't seem to be getting any better from here.

Could anyone advise how long it usually takes for this to heal? Does the continuing (albeit not as bad) pain mean that I need to go back in and more manipulation is in order or is it best to just wait for now (the pain started last Thursday morning, I went to the physiotherapist on Saturday morning, it is now Tuesday afternoon)? And also - can I run if the pain mostly goes when I'm doing so?

[alophysio]

hi

Usually as soon as the manipulation occurs, the walking is restored but the pain can persist for a few days.

For a cuboid to sublux, it will usually sprain a few ligaments along the way so treat it like a 3-6 week injury - kind of like an ankle sprain.

You physio should be able to give you more precise times based on your condition.

To be honest, it doesn't sound like cuboid syndrome - usually you have to do something to make it "get stuck"...was there any incident?

Thanks

[lazerpixie]

Thanks, alophysio, I appreciate the reply!

Just as with the OP, I have no idea what could've caused it. One morning it just popped up.

The one thing I can think of is that I did a large volume of running (large for me) on that previous Sunday - barefoot running clinic with drills, 5km run, then 18km run. I just took it too hard, my own stupidity. After the 18km run I was beat with lots of calf pain and some pain behind the knee. There was also quite a bit of foot pain (what I thought was blisters but turned out to just be some mild redness when I got home, I run in VFF). However I analysed myself and took note of what hurt very carefully after the run and the pain I'm getting now was definitely not a part of it at the time. All foot pain disappeared the same night, calf pain persisted for a few days and my foot didn't start hurting again until that Thursday morning when this popped up.

The worry I have is I'm scheduled to run my first HM in August - is it safe to build my distance back up slowly over the next week or so? The physio said that I can run if I can handle the pain and it shouldn't do any more damage (except for maybe the cuboid shifting again and having to go back for more manipulation), but I've since read that it can do more damage to run with this?

Edit: Oh, not sure if this could have caused it, but I just remembered: I did have to sprint for the bus in very hard boots (flat, but a very sharp heel and uncomfortable) the morning before, on Wednesday. Although I've done this before and the pain didn't come up until the following morning.

[alophysio]

hi lazerpixie,

It is really hard for me to comment on what you can and can't do. There simply isn't enough information for me to tell and I haven't seen you personally.

What do you think you can manage? Do you think it will cope or get worse if you increase your mileage?

Do you normally run 21km in VFF or have you just started?

How heavy are you?

How is your foot alignment?

Are you strong enough to run barefoot?

How elite or fit are you? Asking a proper, long time, properly coached runner to push thru the main might be ok in some cases but for the average punter, i think it isn't very wise...

Lastly, it just doesn't sound like the whole picture points to cuboid syndrome...this is how they seem to present to me in my clinic (and rarely overall really)...
1. Twisting of the foot while loading the leg and foot
2. Can't put weight onto the outside of the foot - usually happy to walk on the heels, not toes
3. Manipulation causes INSTANT relief of pain and restores ability to walk again with only minor soreness compared to sharp pain
4. taping allows normal activities to occur
5. no pain anywhere else in the leg or foot - just over the prominent cuboid.

Now i realise you can get cuboid sprains without the subluxations etc but it is essentially the same thing. If it isn't like the description above, to me, it isn't really cuboid syndrome - i would go and check you from your neck to your thorax, spine, pelvis, hips, knees, ankles and feet to work out why you have the pain...

...but that's just me

Best to trust your gut...what do you think?

[lazerpixie]

Sorry, I know you can't really offer any advice that personal without seeing me, I just need to remember that In response to your questions:

I think I can manage at least trying to increase my mileage. Considering I feel no pain when actually running, I'm a little more worried about doing damage that might affect me post-run, as during the run my foot feels fine.

I've been increasing my distances and run frequencies over the past 2-3 months and running in the VFFs overall for about 8-9 months. I've done 21km in the VFFs once several weeks ago and felt better than I thought I would, with very little calf soreness and no foot problems whatsoever. Since then I've done between 14 and 18km runs in them, all of them feeling totally fine except that last 18km being the toughest on my legs (I suspect because of the amount of running I had already been doing prior to this that same day).

Haven't weighed myself in a while, but normally from memory weigh in anywhere between 43kg and 47kg, 5'4 in height.

I overpronate and used to have knee problems (pain, leg buckling under me when going up or down stairs sometimes because of sharp knee pain) until I started running, but then started having shin splints in my regular shoes, which is why I decided to try something else. So far haven't had any injuries other than this foot thing in the VFFs, no more knee pain or shin splints, but my legs are still built weirdly.

Regarding strength when running barefoot - I don't run totally barefoot because there's often glass and such in the roads here so I've been running in Vibram Bikilas. I'm not sure how to tell if I'm strong enough, but so far except for this weird foot thing that came about while I wasn't even running I haven't had any injuries.

I'm pretty fit for the average person, but not elite and don't run competitively. Run 5km in ~23 minutes, so nothing pro.

Hmm, maybe it isn't cuboid syndrome...Taping did make it better, I don't have pain anywhere else and manipulation did provide relief but I can't remember twisting the foot. When the pain was sharp I did tend to kind of instinctively try to twist my foot in and land on the inside part (overponate on purpose) because that hurt less than pressing down on the edge. I think the reason it hurts me on the heel instead of the toe is because I still have to roll through the step. Right now the pain is mostly when the weight shifts around that area where the pain is, so rolling from heel to toe when walking. If I step on my toe there's no rolling and no pain. That's just what I noticed, not sure if this is really the reason.

Anyway, I guess I just have to see how it feels and be careful :S