Article Full Title

Examination and Treatment of Cuboid Syndrome: A Literature Review

Author Names

Durall, C.

Reviewer Name

Anastasia Engelsman

Reviewer Affiliations

Duke University School of Medicine, Doctor of Physical Therapy Division

Paper Abstract

Context: Cuboid syndrome is thought to be a common source of lateral midfoot pain in athletes. Evidence Acquisition: A Medline search was performed via PubMed (through June 2010) using the search terms cuboid, syndrome, subluxed, locked, fault, dropped, peroneal, lateral, plantar, and neuritis with the Boolean term AND in all possi- ble combinations. Retrieved articles were hand searched for additional relevant references. Results: Cuboid syndrome is thought to arise from subtle disruption of the arthrokinematics or structural congruity of the calcaneocuboid joint, although the precise pathomechanic mechanism has not been elucidated. Fibroadipose synovial folds (or labra) within the calcaneocuboid joint may play a role in the cause of cuboid syndrome, but this is highly speculative. The symptoms of cuboid syndrome resemble those of a ligament sprain. Currently, there are no definitive diagnostic tests for this condition. Case reports suggest that cuboid syndrome often responds favorably to manipulation and/or external support. Conclusions: Evidence-based guidelines regarding cuboid syndrome are lacking. Consequently, the diagnosis of cuboid syndrome is often based on a constellation of signs and symptoms and a high index of suspicion. Unless contraindicated, manipulation of the cuboid should be considered as an initial treatment.

NIH Risk of Bias Tool

 Quality Assessment of Systematic Reviews and Meta-Analyses 

  1. Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis
  1. Is the review based on a focused question that is adequately formulated and described?
    • No
  1. Were eligibility criteria for included and excluded studies predefined and specified?
    • Yes
  1. Did the literature search strategy use a comprehensive, systematic approach?
    • Cannot Determine, Not Reported, Not Applicable
  1. Were titles, abstracts, and full-text articles dually and independently reviewed for inclusion and exclusion to minimize bias?
    • Yes
  1. Was the quality of each included study rated independently by two or more reviewers using a standard method to appraise its internal validity?
    • Cannot Determine, Not Reported, Not Applicable
  1. Were the included studies listed along with important characteristics and results of each study?
    • No
  1. Was publication bias assessed?
    • No
  1. Was heterogeneity assessed? (This question applies only to meta-analyses.)
    • Cannot Determine, Not Reported, Not Applicable

 

Key Finding #1

Diagnosis of cuboid syndrome has been made with high suspicion given the lack diagnosis procedures, instead relying on the patient’s symptoms and history.

Key Finding #2

Cuboid syndrome may respond favorably to manipulation of the cuboid.

Key Finding #3

Manipulations, such as the cuboid whip and cuboid squeeze, may increase heel raise tolerance and decrease discomfort with dorsal-plantar cuboid gliding for patients with cuboid syndrome.

Please provide your summary of the paper

Cuboid syndrome, or a dysfunction of the arthrokinematics of the calcaneocuboid joint, is difficult to identify clinically and is thus, easily misdiagnosed. It is commonly mislabeled as a lateral ankle sprain as symptoms resemble those of a ligament sprain and may occur due to an inversion ankle sprain. This pathology has been shown to respond well to manipulation. Two manipulations commonly used include the cuboid whip and cuboid squeeze. Additional manipulations may be used to relieve pain and improve heel raise tolerance. Other modalities, such as cryotherapy and padding to support the plantar cuboid, may be warranted to achieve full resolution of symptoms and/or prevent recurrence.

Please provide your clinical interpretation of this paper.  Include how this study may impact clinical practice and how the results can be implemented.

Following this article, it would be necessary to develop more detailed evidence based practice guidelines for cuboid syndrome. This pathology is commonly misdiagnosed and requires more research to determine what key factors make this different from lateral ankle sprains. This study did, however, clearly outline helpful treatments for cuboid syndrome. Manipulations such as the cuboid whip and cuboid squeeze were given with instructions and proper dosage, thus making it easy for clinicians to implement. Because these manipulations have had high success, they should be adopted by clinicians and utilized in treatment. Furthermore, this article highlighted why clinicians should consider cuboid syndrome in their differential diagnosis of lateral foot pathologies.