cuboid syndrome

[tstrelioff]

I am wondering if anyone has an article link to the diagnosis and treatment of this condition. It is common in dancers, and is a 'subluxation' of the cuboid bone, and is managed by a 'j stroke' manipulation.

I have misplaced the original article I had, and am wondering if any one out there in the physio community can help me with this one.

Thanks

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[Physiobase]

Cuboid Syndrome here's some info I found on the web

Cuboid syndrome refers to the disruption of the normal function of the calcaneal-cuboid joint (CC joint). Disruption of the CC joint is often called subluxation. Cuboid syndrome can be found described in the literature as a sequella of inversion sprains of the ankle. Also, cuboid syndrome is found described in dance (ballet) literature.

Cuboid syndrome is somewhat uncommon and is poorly defined in the literature. When conditions are poorly defined in the literature, this usually means that there is a lack of agreement among doctors as to the eitiology (reason for the condition) and the treatment.

Treatment Of Cuboid Syndrome

Cuboid syndrome is treated by reducing (realigning) the subluxation of the CC joint and stabilizing the reduction. Reduction of the subluxation can be accomplished by manipulating the joint. Manipulation is performed with the patient in a prone (face down) position. The practitioner cradles the foot in his/her hands and places both thumbs beneath the CC joint. The CC joint is then manipulated by a forceful movement, moving the leg at the knee and the ankle while applying pressure with the thumbs at the plantar (bottom) aspect of the CC joint.

Reduction of the subluxation can be maintained with taping, and padding. Prescription orthotics (arch supports) are helpful in preventing a recurrence of cuboid syndrome. Occasionally, cortisone injections may be helpful in reducing inflammation associated with the subluxation of the CC joint. Patients are instructed to avoid going barefoot or wearing shoes with low heels. Small (less that 1/2") heel lifts can also be helpful.

Chronic cuboid syndrome is called tarsitis (inflammation of the tarsal bones). Tarsitis results from excessive intrinsic load, often called CT band syndrome. Tarsitis is just one of many symptoms of CT band syndrome. For additional information regarding chronic cuboid syndrome (tarsitis), please read our article on CT band syndrome.

The response to treatment of cuboid syndrome depends upon the eitiology and onset of symptoms. Acute onset of cuboid syndrome, say from an ankle sprain, may respond dramatically to manipulation. If cuboid syndrome is due to chronic, excessive intrinsic load (CT band syndrome) treatment such as manipulation may be less effective and take longer to see results.

Biomechanics: these are important considerations

Cuboid syndrome occurs at the calcaneal-cuboid joint (CC joint) on the lateral or outside of the foot. The CC joint functions together with the talo-navicular joint (TN joint) and the subtalar joint (STJ) to deliver load to the forefoot. The function of these joints is to deliver load that can be converted into action; walking, running etc. For additional definitions of load in relationship to the normal function of the foot and leg, please refer to our article on CT band syndrome.

Cuboid syndrome occurs when the calcaneal-cuboid joint is unable to carry the load that is applied to it. The result is that the calcaneal-cuboid joint subluxes (moves out of its' normal position).

[tstrelioff]

WOW! Thanks so much for your efforts, and your literature information, that is great!
Funny, I did recall much of what you described, based on the journal article I read many moons ago. You will be glad to hear, that due to the mobilization, and eventual manipulation of the C.C joint, followed with padding and strapping the area, the patient in 2 visits is 90 % improved.

She was delighted to find someone who was able to treat it so quickly and successfully. She did not have any trauma, is a 55yr old female, and the injury happened as she tried to 'power' walk one day. Could not continue to walk and needed to be nearly carried home. Strong medications did nothing for her, and she hobbled into the clinic.

thanks again

[Physiobase]

great news

[stirlingpt]

An excellent article on Cuboid Syndrome (diagnosis, treatment etc) can be found in the American Journal of Sports Medicine Vol 20 No 2 p169ff. Its an old article (1992) but still one of the best I've seen.

[wernerspine]

Hi Friend
I recommend that you become familiar with the use of databases like medline/embase/cinahl/pedro/.

I found this article in medline a combination of text words cuboid and manipulation

jennings J. Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. [Journal Article] Journal of Orthopaedic & Sports Physical Therapy. 35(7):409-15, 2005

[jerryhesch]

Good answers re the topic of cuboid syndrome. I have treated this for 2 decades so have some thoughts. I intended to submit a letter to the editor after the article cited earlier in JOSPT in 2005, but never did. There are essentially 2 basic types of cuboid syndrome and I do not believe that this has been adequately addressed in the literature. For convenience I am going to name one type a Type I and the other Type II.
Type I. Can be symptomatic or asymptomatic. It responds beautifully to a manipulation of the cuboid and the cuboid alone. If painful, the pain resolves very quickly and the treatment is repeated 1 or 2 times. Client and clinician are both happy. Recovery is quick. Basically the cuboid fixation is the key lesion in the foot and ankle complex and restoring mobility directly to the cuboid makes for significant improvement. Sometimes there is a pattern that appears to involve several other structures in the foot and ankle, yet the manipulation performed only at the cuboid is almost magical. Retesting the other motion fixations reveals that they are also remarkably improved and they do not require treatment. I affectionately refer to the cuboid as 1/2 of a keystone - and I do this metaphorically. It is very helpful to have a foot and ankle model that includes the whole foot and a short portion of the distal tibia and fibula, of course talus and calcaneus included. Take apart the joint leaving the forefoot, the cuneoforms, the navicular and the cuboid as one and the talus and calcaneus are seperate as is the distal tibia and fibula. It is so helpful to learning. You can put the pieces together and observe how the bones interact. It should be easy to perceive how the cuboid is "out there by itself" being most lateral and it is easy to see how it could be elevated and remain stuck in an inversion injury.
The cuboid can be palpated and compared to the unaffected side. Typically it is more prominent on the painful side and inferior glide spring testing and "pronatory" spring testing reveal fixation. I do not believe that onecan accurately perform a superior glide spring test due to thickness of the thickness of the soft tissue on the plantar surface of the foot. The typical manipulation appears to enhance the lesion - yet gap the joint and I believe that it recoils back to normal position. I prefer to mobilize it with progressive inferior glide and medial rotation mobilization.
Now a description of what I conveniently refer to as Type II. This can be symptomatic or asymptomatic, with all grades in between from acute to chronic. The difference is that a supinatory pattern of the foot and ankle complex has set in and efforts to mobilize only the cuboid will fail miserable, will not provide that quick fix. Instead, you have to treat all major articulations and this is where we get into some controversy. (Actually the direction in which I describe it re position and mobilization is contrary to most if not all of the literature-so here is more controversy). I find restrictions and restore mobility in the following directions:
posterior glide of the talus - the method also mobilized the calcaneus anteriorly at the same time
+ or - posterior glide of distal tibia
internal rotation of the talus
posterior glide of the distal malleolus
+ - ant or post glide of fibular head
superior glide of the fibula (not described in the literature, but indeed a seperate accessory motion - great research project)
inferior glide and medial rotation of the navicular and then incorporating the cunieoforms
inferior glide and medial rotation to the cuboid
At this point one will typically note that the calcaneus still has restricted eversion and abduction and the secret to restoring valgus (ultimately to restore normal pronation) is actually to mobilize the above sequence and then the calcaneus 30x into abduction and the valgus is then restored automatically without directly performing a valgus/eversion force. the abduction is the key - of course, after the above sequence. I think that I might be one of the first to namethe abduction - I just stumbled on it many years ago - but spank me if I am wrong.
Sometimesbefore the final mob to the calcaneus I will evaluate and treat if needed, medial glide to the talus working through the distal fibula and just below it as well.
After all of the above I go into a weight-bearing context and adress those motions that I can - if I find them to be restricted in weight bearing such as distal tibia rotation, calcaneal valgus, etc. I teach the client to internally rotate from hip down to distal tibia and gentley repeatedly self-mobilize into pronation 30-100 reps.
There are other flavors in which there is enough laxity in the ligaments that the above is not effective, fortunatley these are in the minority and I am not referrring to this sub-population is this commentary.
there is a great need for more research on the above topic and I think that our profession does not typically look at structures as patterns of motion dysfunction the cuboid syndrome a perfect example in which only 1 mobilization is described. After restoring normal motion, stability, strength, blance, endurance, proprioception, etc it is very appropriate to look up the kinetic chain and find out where the body has adapted or compensated for this pattern and treat what you find. Typically I end up treating the pelvis/SI and upper cervical spine, though if the pattern iis not chronic; the compensation may reflexively resolvewith no direct effort on my part.
enough!
Jerry Hesch, MHS, PT
[email protected]

[tstrelioff]

Thanks again for all the great information. Yes, I agree it is an area that is worth some investigation.

I am very poor at navigating the data bases, and rely on my computer savy friends to sent me the direct links to the articles. Hint Hint!!

thanks