What is the Cuboid bone of the foot?

The cuboid bone is one of 26 bones of the human foot. It is the bone that articulates posteriorly with he calcaneus and anteriorly with the 4th and 5th metatarsals.

Cuboid stress fractures is an easily misdiagnosed source of lateral midfoot pain, and is believed to arise from a subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid (CC) joint with repetitive high stress loads applied to this scenario.

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How is it commonly injured

Several causes have been proposed for cuboid stress fractures, including:

• excessive pronation, a well as reduced pronation has been involved with this injury

• overuse, 

• inversion ankle sprains

• A disruption of joint congruity with high forces (like in long jump events) can lead to stress injuries to this bone

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Diagnosis and Signs and Symptoms of this injury

• Grade of stress fracture will need to be determined: Grade 1,2,3,4 - the higher the grade the more severe the injury and the longer amount of rest needed

• Pain is often along the outside of the foot towards the red circled in the picture above.

• Direct palpation of the cuboid one and its surrounding structures  will normally be painful, along with the trace of the peroneal tendons.

• Resisted foot external rotation may also be painful.

• Vibration tuning fork applied to the cuboid bone may be clinically diagnostic but gold standard scan here is MRI 

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Current management techniques

• Management depends on the grade of stress fracture diagnosed.

• Walker boot for 6+ weeks if confirmed as Stress fracture. Re-examine MRI for evidence of healing before coming out of the boot.

• Rest Ice, Compression, Elevation: all these techniques help to control the swelling and pain.

• Often reducing the rotation movements at this part of the foot is useful with stabilisation using orthotic therapy to keep the CC joint on the same plane thus reducing incongruity

• Minimisation of strength losses via specific foot exercises

• Minimisation of range of motion loss via specific foot exercises

• Rehabilitation is important as a lot this type of pain can develop and get worse quickly due to the number of steps we take each day.