pathology: cuboid syndrome

yogabook / pathology / cuboid syndrome

Definition

Cuboid syndrome is a vaguely defined disorder associated with the calcaneocuboid joint, in the vicinity of which laterally emphasised pain phenomena occur. Painful restriction of movement or painfully limited strain are also described. A broad radiation of pain is possible, even in the direction of the fibularis group. The strain pain then has a stabbing flavour, but a dull rest pain is also possible. The rolling movement of the foot and the position of the toes can be painful or impossible due to pain. Depending on the assumed aetiology, which includes trauma such as supination trauma (inversion trauma), but also overuse, the pain phenomenon can creep in or occur suddenly. The course and duration are variable, and pain-free intervals can also occur. It mainly affects athletes whose exercise includes running components, including those with rapid changes of direction such as basketball and tennis, but also ballet dancers. Competitive athletes are significantly more frequently affected than non-athletes. Predisposing factors include obesity, poorly fitting or worn-out footwear, instability of the metatarsus, Training on uneven surfaces, inadequate training status, previous trauma leading to joint instability. The kink– lower foot/ kink– flat foot is also discussed as a predisposing factor. It is possible that after a supination trauma, the cuboid in the calcaneocuboid joint remains in a residual supination, a dorsal or plantar subluxation are also discussed, which may be based not least on the fact that the eversion torque in the calcaneocuboid joint cannot be absorbed by the passive structures, which is generated by a supination trauma reflexively maximally contracted fibularis longus. The passive structures such as capsule and ligaments can be damaged, resulting in instability. If there is a subluxation, the joint is no longer mobile. The cuboid may protrude dorsally or be retracted plantarly and pressure on it causes pain. While the typical complaints of supination trauma such as swelling, pressure pain over the lateral ligaments and pain on weight-bearing will subside over time, the malalignment and pain will remain in the unreduced calcaneocuboid joint. In dancers, the pathomechanism usually lies in iterated overstraining, which leads to insufficient ligaments. Cuboid syndrome often results in an altered gait pattern to avoid pain. Pain can often be provoked by stretching the sole of the foot (flexion of the foot in itself) or standing on the toes. The beginning of the weight-bearing phase, when a lot of body weight is placed on the foot for the first time, shows a pain maximum, as does the terminal push-off at the end of the leg phase. Torsion of the foot (inversion or eversion of the forefoot) is also often painful. There are few reliable figures on the incidence; one source assumes that 7% of supination trauma causes cuboid syndrome. 17% of dancers are said to be affected by cuboid syndrome.

Cause

  1. Supination trauma
  2. Overuse

Predisposing

  1. Sports with rapid changes of direction
  2. extensive running
  3. Balett
  4. Obesity
  5. Ill-fitting or worn-out footwear
  6. Instability of the metatarsus
  7. Training on uneven surfaces
  8. Inadequate level of training
  9. previous trauma leading to joint instability.
  10. Buckling foot and its consequences Lower foot and Flat foot

Diagnosis

  1. Mainly by clinic, medical history and functional tests/pain provocation test
  2. The MRI may show a slight displacement of the cuboid and can rule out fractures.
  3. Test and sign: Midtarsal Adduction Test, Midtarsal Supination Test

Symptoms

  1. lateral emphasised pain on weight bearing of the tarsus
  2. possibly dull rest pain
  3. Reduced mobility of the cuboid
  4. Painful push-off movement at the end of the stance phase
  5. Cuboid possibly protruding towards dorsal or retracted towards plantar
  6. Painful toe position
  7. Pain may radiate along the outer edge of the foot, possibly in the direction of the fibularis longus

Complications

  1. Secondary disorders due to pain avoidance and changes in gait pattern

Therapy

  1. Rest before pain is triggered
  2. Cooling in case of swelling
  3. Conservative until further notice
  4. Reposition
  5. Stabilisation training
  6. If necessary orthoses
  7. Stretching training for ischiocrural group and triceps surae
  8. Foot gymnastics, reduction of excessive tension of the intrinsic plantar foot muscles
  9. Taping

DD

  1. Frakturen
  2. Painful OS-peroneum-Syndrom
  3. Muskelverletzungen
  4. Nervenkompression
  5. pathologische Synostosen von Fußwurzelknochen (tarsal coalition)

https://youtu.be/eXw36a52avo
https://www.hmpgloballearningnetwork.com/site/podiatry/article/3036
https://www.physio-pedia.com/Cuboid_Syndrome
https://physio.de/community/news/was-ist-dran-am-cuboid-syndrom/99/10982/1
https://www.physiotutors.com/de/conditions/cuboid-syndrom/