In the first part of "Lateral Foot Pain - Cuboid Syndrome," we delved into the symptoms, causes, and biomechanics behind Cuboid Syndrome, shedding light on how this condition impacts foot function and the key factors contributing to its onset.
In this second part, we’ll examine precise examination techniques and effective treatment strategies. You'll gain practical insights into accurately diagnosing Cuboid Syndrome and discover comprehensive therapeutic approaches to relieving pain and restoring foot health.
Article Index:
Examination of Cuboid Syndrome
During a physical assessment for Cuboid Syndrome, several key indicators may be present:
Pain is often localized over the cuboid bone, worsening with dorsal pressure on the plantar surface.
Symptoms like bruising, inflammation, and redness may be observed in some cases.
Ankle flexibility is typically reduced during both dorsiflexion and plantar flexion.
Pain commonly occurs during resisted foot or ankle inversion or eversion.
An antalgic gait, where the patient avoids pain, is often noticeable, especially during the push-off phase of walking and lateral movements.
Key Diagnostic Tests
Two specific tests are useful for diagnosing Cuboid Syndrome:
Midtarsal Adduction Test: Stabilize the ankle and subtalar joint with one hand while applying an adduction force in the transverse plane with the other. Pain during this test may indicate Cuboid Syndrome.
Midtarsal Supination Test: This test assesses the cuboid's involvement by performing inversion in the frontal plane and plantar flexion in the sagittal plane. Pain during this maneuver may suggest Cuboid Syndrome.
Examination Videos
The following videos demonstrate common procedures for analyzing ankles and feet for potential issues.
Ankle and Foot Examination
This video demonstrates orthopedic tests for evaluating common ankle and foot conditions seen in clinical practice, including Ankle Sprains, Cuboid Syndrome, Talar Dome Lesions, 5th Metatarsal Fractures, Syndesmosis damage, Achilles Tendinopathy, Morton's Neuroma, 2nd Metatarsal Stress Fractures, Plantar Fasciitis, and Bunions.
Lower Limb Neuro Examination
The lower limb neurological examination is part of the overall neurological examination process and assesses the motor and sensory neurons that supply the lower limbs. This assessment helps detect any impairment of the nervous system and is used both as a screening and an investigative tool.
Peripheral Vascular Examination - Key Points
A peripheral vascular examination is crucial for identifying vascular-related issues and preventing cardiovascular and cerebrovascular complications. This video covers common procedures used in daily clinical practice.
Imaging
Imaging techniques like X-rays, CT scans, or MRIs are generally less effective for diagnosing Cuboid Syndrome. However, an X-ray can be useful to rule out fractures or other pathologies during the diagnostic process.
Treatment
The treatment for Cuboid Syndrome varies based on the injury's phase and the diagnostic findings regarding the affected structures. In the following sections, we cover:
Acute Phase of Cuboid Syndrome
Manual Therapy for Cuboid Syndrome
Cuboid Whip Manipulation
Cuboid Squeeze Technique
Acute Phase of Cuboid Syndrome
During the acute phase, which typically lasts 2-48 hours after the injury, you may experience swelling, pain, and inflammation in the foot. Here are general recommendations for managing this phase (individual cases may vary):
Rest: Avoid weight-bearing activities. If necessary, use crutches to alleviate pressure on the foot.
Ice: Apply ice to the affected area for 15-20 minutes several times daily for the first 48 to 72 hours. Alternatively, direct ice massage for 7-9 minutes, 2-3 times daily, can be beneficial.
Compression: Use a compression sleeve, wrap, or taping to reduce swelling. Ensure it’s snug but not too tight to maintain circulation.
Elevation: Elevate your leg above heart level, especially at night, to reduce pain and swelling.
Foot Mobility Exercises: Perform gentle, non-impact range-of-motion exercises, staying within a pain-free range.
Start Manual Therapy ASAP: In most cases, manipulation and soft tissue therapy can begin immediately. The specific techniques will depend on the individual case.
Osseous Manipulation
Osseous manipulation is commonly recommended for treating Cuboid Syndrome, unless contraindicated by fractures, infections, active inflammatory arthritis, or vascular disease.
Cuboid Whip and Cuboid Squeeze Techniques
Cuboid Whip Manipulation: In this technique, the patient lies face down with their knee flexed at 70 to 90 degrees. The clinician cups the top of the foot, placing their thumbs on the inner side of the cuboid bone. With the patient's leg relaxed and the ankle in a neutral position, the clinician "whips" the foot into inversion and plantar flexion while applying a high-velocity, low-amplitude thrust to the cuboid.
Cuboid Squeeze Technique: For the Cuboid Squeeze, the clinician stretches the ankle into maximum plantar flexion and flexes the foot and toes fully. Once the soft tissues relax, the cuboid is "squeezed" dorsally using the thumbs.
Beyond the Cuboid Bone
Addressing Cuboid Syndrome may require more than just adjusting the cuboid bone. Loosening restrictions in other parts of the ankle and foot might be necessary. In the following demonstration video, Dr. Abelson illustrates the process. Please note that this video is for demonstration purposes only and should not be considered as a therapeutic recommendation.
MSR - 7 Point Ankle & Foot Mobilization
Improving joint mobility is essential for effectively treating Cuboid Syndrome and addressing the body's entire kinetic chain. Without addressing joint mobility restrictions, myofascial treatments are significantly less effective. Joint mobilization helps reverse negative physiological changes by enhancing movement between capsular fibers, which is crucial for restoring proper function in conditions like Cuboid Syndrome.
Soft Tissue Treatment
In addition to focusing on the cuboid bone, addressing any soft tissue restrictions involving muscles, tendons, ligaments, fascia, and nerve entrapments is crucial. Conservative therapy can be highly effective for this purpose. The following demonstration videos highlight procedures that can address soft tissue restrictions in cases of Cuboid Syndrome.
4 Point Dorsi Flexion Protocol - Motion Specific Release (MSR)
Dorsiflexion is the movement at the ankle joint where the toes are brought closer to the shin. The shins' muscles help your foot clear the ground during the Swing Phase (concentric contraction) of your stride and absorb much of the impact shock during running.
MSR Calf Muscle + Tom, Dick, and Harry Release
In the video, Dr. Abelson, the developer of MSR, demonstrates how to effectively release both the superficial calf muscles (gastrocnemius and soleus) and the deeper muscles Tom, Dick, and Harry (TDH). Tom, Dick, and Harry stand for T=Tibialis posterior, D=Flexor digitorum longus, an=posterior tibial artery and tibial nerve, and H=Flexor hallucis longus.
Facial Expansion: MSR Foot Pain Protocol
Using fascial expansions to treat cuboid syndrome offers a holistic approach that integrates modern insights into fascia's role, kinetic chain relationships, and essential principles from acupuncture and traditional Chinese medicine.
This method links fascial lines with specific acupuncture points such as ST44, LV3, LV2, K3, and B60, forming a cohesive treatment plan. Addressing the misalignment and inflammation associated with cuboid syndrome is a comprehensive strategy that helps reduce pain, enhance tissue mobility, and manage scar tissue. It also aims to restore proper alignment and function of the cuboid bone and surrounding structures, ultimately alleviating discomfort and preventing further complications related to cuboid syndrome.
Tailored Treatment Frequency for Cuboid Syndrome
Our treatment plan for Cuboid Syndrome is customized to each patient's recovery, ensuring optimal results through regular assessments.
Initial Treatment Phase:
Objective: Reduce inflammation, alleviate pain, and promote healing.
Frequency: Two sessions per week (15 minutes each) or one session per week (30 minutes) for 2-4 weeks.
Response Assessment:
After 2-4 Weeks:
Positive Response: Reduce to 1 session per week.
Persistent Symptoms: Continue with two sessions (or one 30-minute session) per week, reassessing weekly.
Cessation of Treatment:
Complete Resolution: Discontinue if the patient is pain-free and fully functional.
Lack of Progress: Consider referral if there is no improvement after 6-8 weeks.
Maintenance Care (If Needed):
Objective: Maintain progress and prevent recurrence.
Frequency: Once every four weeks, extending intervals as long as symptoms don’t return.
Exercises for Cuboid Syndrome
Physical activity is essential in any effective therapy plan. As patients progress beyond the acute phase of Cuboid Syndrome, their exercises should focus on three key areas: flexibility, muscle strengthening, and balance.
The following demonstration videos highlight a variety of exercises that may be recommended for patients with Cuboid Syndrome. These exercises are tailored to meet each patient's unique needs, ensuring a personalized and effective approach to recovery.
Peroneal Muscle - Stretching & Myofascial Release
The peroneal muscles are a key link in foot stability. This video shows you several ways to stretch and release myofascial restrictions.
Stretching Your Calf Muscles
This video shows calf stretches for both your calf muscles, the gastrocnemius and soleus. Minor changes in technique can make a huge difference in increasing your calf flexibility.
Foot & Ankle Strengthening Routine
This foot and ankle strengthening routine uses a Theraband to work the flexors, extensors, and internal and external foot rotators.
Improve Your Balance - Exercises for Beginners
Balance exercises are a fundamental aspect of training that should not be ignored in rehabilitation or Sports Performance training. Improve your balance with these simple exercises. Using our progression techniques, you can ensure that you perform these exercises safely without increased risk of injury.
Why Choose Our Approach for Cuboid Syndrome Treatment
Our comprehensive approach to treating Cuboid Syndrome consistently achieves a 90% success rate in reducing pain and restoring foot function. Here's why our method stands out:
Established Expertise: Developed by Dr. Brian Abelson, the MSR methodology is backed by over 30 years of clinical experience and the successful treatment of more than 25,000 patients, ensuring you receive the highest standard of care.
Thorough Assessments: We perform detailed evaluations to identify all contributing factors, including biomechanical issues and joint restrictions often present in Cuboid Syndrome.
Advanced MSR Procedures: Our Motion-Specific Release (MSR) techniques precisely target areas of fascial restrictions and joint dysfunction, providing effective and targeted relief.
Customized Exercise Programs: We design individualized exercise plans to enhance joint mobility, strengthen the foot, and restore function, supporting your full recovery.
Logical, Evidence-Based Approach: Our treatment protocols combine manual therapy, exercises, and supportive measures to ensure a comprehensive and lasting solution.
Choose our proven, patient-centred approach for effective, long-term relief from Cuboid Syndrome. Take the first step toward your recovery with confidence.
REFERENCES - PART 2
Cuboid subluxation in ballet dancers. Marshall P, Hamilton WG Am J Sports Med. 1992 Mar-Apr; 20(2):169-75
The talonavicular and calcaneocuboid joints: anatomy, biomechanics, and clinical management of the transverse tarsal joint. Sammarco VJ Foot Ankle Clin. 2004 Mar; 9(1):127-45.
Rademaker J, Sadka Rosenberg Z, Delfaut EM, et al. Tear of the peroneus longus tendon: MR imaging features in nine patients. Radiology 2000;214:700-704.
Chopart's joint load during gait. In vitro study of 10 cadaver specimen in a dynamic model. Suckel A, Muller O, Langenstein P, Herberts T, Reize P, Wulker N Gait Posture. 2008 Feb; 27(2):216-22.
Durall CJ. Examination and treatment of cuboid syndrome: a literature review. Sports Health. 2011;3(6):514-9. doi: 10.1177/1941738111417565
Jennings J, Davies GJ. Treatment of cuboid syndrome secondary to lateral ankle sprains: a case series. J Orthop Sports Phys Ther. 2005;35(7):409-15. doi: 10.2519/jospt.2005.35.7.409
Mooney M, Maffey-Ward L, Ganley EJ. Cuboid plantar and dorsal subluxations: assessment and treatment. J Orthop Sports Phys Ther. 1999;29(9):546-52. doi: 10.2519/jospt.1999.29.9.546
Adams E, Madden C. Cuboid subluxation: a case report and review of the literature. J Am Podiatr Med Assoc. 2009;99(4):348-54. doi: 10.7547/0980348
Kaeser M, Wyss C, Bashir S, Brunner R. Subluxation of the cuboid bone: a case report. J Foot Ankle Surg. 2014;53(4):467-71. doi: 10.1053/j.jfas.2013.09.012
Price C. The role of the cuboid in the foot: a review of the literature. Foot Ankle Surg. 2019;25(5):609-13. doi: 10.1016/j.fas.2018.10.010
Newell SG, Woodle A. Cuboid syndrome. Phys Ther. 1981;61(1):42-4. PMID: 7450760
Cohen I. Cuboid syndrome. J Am Podiatr Med Assoc. 1983;73(11):577-82. doi: 10.7547/87507315-73-11-577
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DR. BRIAN ABELSON, DC. - The Author
With over 30 years of clinical practice and experience in treating over 25,000 patients with a success rate of over 90%, Dr. Abelson created the powerful and effective Motion Specific Release (MSR) Treatment Systems.
As an internationally best-selling author, he aims to educate and share techniques to benefit the broader healthcare community.
A perpetual student himself, Dr. Abelson continually integrates leading-edge techniques into the MSR programs, with a strong emphasis on multidisciplinary care. His work constantly emphasizes patient-centred care and advancing treatment methods. His practice, Kinetic Health, is located in Calgary, Alberta, Canada.
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Elevate your clinical practice with our Motion-Specific Release (MSR) courses and MSR Pro services, designed to provide a comprehensive, evidence-based approach to musculoskeletal care. Here’s why you should join us:
Proven Methodology: Developed by Dr. Brian Abelson, an international best-selling author with over 30 years of clinical experience, MSR integrates the most effective elements of osseous and myofascial therapies. With a success rate exceeding 90%, our approach helps set a new industry standard.
Comprehensive Training: Our courses blend rigorous academic content with innovative techniques. You’ll master essential areas like orthopedic and neurological examinations, myofascial treatment, fascial expansions, and osseous adjusting and mobilization.
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