Cuboid syndrome is a condition caused by a dysfunction of the cuboid bone in the foot. It can cause pain and discomfort with weight-bearing activities such as walking and standing. The cuboid bone is located near the outer side of the foot. Problems can develop that make the cuboid bone shift and dislodge from its normal position. Cuboid syndrome most often affects athletes and dancers, although anyone can experience it. Age does not seem to play a role.

The prevalence of cuboid injuries in the United States is not clearly known. It has been diagnosed in 6.7% of patients with inversion ankle sprains (when the ankle rolls outward and the foot rolls inward). Approximately 4% of athletes who report foot injuries have symptoms from the cuboid bone. Cuboid syndrome is found in about 17% of professional ballet dancers. It can occur from trauma or without any recalled injury. Physical therapists design individualized treatment programs to help people with cuboid syndrome. Proper treatment can help them reduce pain, regain lost strength and movement, and get back to their normal lives.

Physical therapists are movement experts. They improve quality of life through hands-on care, patient education, and prescribed movement. You can contact a physical therapist directly for an evaluation. To find a physical therapist in your area, visit Find a PT.

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On this page

• What Is Cuboid Syndrome?
• How Does It Feel?
• Signs and Symptoms
• How Is It Diagnosed?
• How Can a Physical Therapist Help?
• Can This Injury or Condition Be Prevented?
• What Kind of Physical Therapist Do I Need?

What Is Cuboid Syndrome?

The cuboid bone is one of the 26 bones of the foot. It is located on the outer side of the foot, about halfway between the pinky toe and the heel bone. The cuboid bone moves and shifts to a small degree during normal foot motion. Certain forceful movements or prolonged positions can cause the cuboid bone to shift. This may interfere with its normal position or motion, and causes immediate foot pain that can worsen when standing or walking.

Cuboid syndrome can occur suddenly. It may occur with ankle sprains, as the foot rolls in, or when a person stomps the foot onto a hard surface, such as concrete. This is particularly possible if the person is wearing rigid or high-heeled shoes. Hard landings from a jump or falling from a height onto the feet can create enough force to affect the cuboid bone's position.

A cuboid bone injury can develop from maintaining prolonged foot positions. These may include standing or walking in high heels or remaining in a toe-pointed (ballet dancer's) position for a long time. Weakness of the ankle muscles can also contribute to injury.

The majority of people who have cuboid syndrome have flat feet. However, the condition can also occur in people with very high arches.

How Does It Feel?

Cuboid syndrome causes sharp pain on the outer side of the foot, and possibly on the underside. The pain does not usually spread to the rest of the foot or leg. It often starts quite suddenly and lasts throughout the day. Pain can worsen with standing or walking and can make walking on the foot impossible. The pain is often completely relieved by taking weight off the foot. When not putting weight on the foot, a person can usually move the foot around freely with little to no pain. Without treatment, however, the pain during standing and walking can persist for days, weeks, or longer.

Surgery is not usually necessary for the treatment of cuboid syndrome. Your physical therapist can help determine if cuboid syndrome is present. They can design a tailored treatment program for you based on your specific condition and goals.

Signs and Symptoms

Cuboid syndrome can cause any of the following symptoms:

• Sharp pain on the outer side, and possibly underside, of the foot.
• Increased pain when standing and/or walking.
• Limping when walking, or an inability to walk on the foot at all.
• Reduced pain when no weight is put on the foot.
• Possible mild swelling on the outer side of the foot.

How Is It Diagnosed?

Your physical therapist will conduct a thorough evaluation, including a review of your health history. They also will ask you detailed questions about your injury, such as:

• How and when did the pain start?
• What type of discomfort do you feel, and where do you feel it?
• What can’t you do right now in your daily life, work, or sport, due to the pain?

Your physical therapist may perform tests and measures to assess the:

• Alignment of the foot and ankle on the unaffected and affected sides
• Range of motion of the foot and ankle
• Strength of the muscles in your foot, ankle, knee, and hip
• Joint mobility

Tests of function may include standing, walking, stair climbing, and/or running.

If more severe problems are suspected or found, your physical therapist may collaborate with a physician to obtain special diagnostic testing, such as an X-ray. Physical therapists work closely with physicians and other health care providers to make certain that you receive an accurate diagnosis and proper treatment.

How Can a Physical Therapist Help?

Cuboid syndrome often responds quickly to the right treatment.

Your physical therapist will work with you to design a specific treatment program based on your condition and goals. It will promote a gradual return to activities, including exercises and treatments you can do at home. Physical therapy will help you return to your normal lifestyle and activities. Full recovery can occur within a few weeks or less when a proper treatment program is implemented.

During the first 24 to 48 hours following your diagnosis of cuboid syndrome, your physical therapist may advise you to:

• Avoid all jumping, hopping, and running activities.
• Limit prolonged walking.
• Wear comfortable, supportive shoes.
• Stay active within your limits of pain tolerance, under the guidance of your physical therapist. Movement and exercise will decrease pain and stiffness and improve your recovery.
• Apply ice packs to the affected area.

Your physical therapist will work with you to relieve your pain and restore function. Your treatments may include:

Manual therapy. Your physical therapist may use hands-on treatments (manual therapy). They will gently help to mobilize or manipulate the joints of the rearfoot, midfoot, and forefoot. This can help increase motion and decrease pain. These techniques help reposition and stabilize the cuboid. Doing so can relieve most of the pain and help restore your ability to stand and walk. They will then design exercises for you to build and maintain the strength, stability, and flexibility of the foot and ankle.

Activity modification strategies. Your physical therapist will help you understand how to avoid or modify the activities that led to your injury. The focus will be on physical therapy treatments, gentle movement to reduce pain, and a gradual progression to return to daily activities and exercise. Your physical therapist may teach you how to choose the best footwear. This is important to help you avoid putting unwanted pressure on the cuboid bone. They also may suggest that you add specialized support such as orthotics. Once your pain is gone, it will be important for you to continue your prescribed exercises at home. Doing so will help keep your foot healthy and pain-free.

Improving motion. Your physical therapist will choose specific activities and treatments to help restore normal movement. These might begin with "passive" motions that the physical therapist performs to move your joints. They may progress to guiding you through active exercises and stretches that you do yourself. You can perform these motions at home and in your workplace to help hasten healing and pain relief.

Improving flexibility. Your physical therapist will determine if any muscles in the area are tight. They can train you to carefully stretch the affected muscles. They also can teach you stretching exercises to do at home.

Improving strength. Your physical therapist can teach you the correct exercises to steadily restore your strength and agility. Foot and ankle exercises are commonly taught to address cuboid syndrome. They help strengthen the muscles and tendons around the cuboid bone, arch of the foot, and the ankle.

In all but the most extreme cases, physical therapist treatment provides excellent results. Surgery and pain medication (such as opioid medication) are not usually needed for this condition.

Can This Injury or Condition Be Prevented?

Risk factors for cuboid syndrome include:

• Foot bone instability
• A sprained ankle
• Being overweight
• Wearing poorly-fitted or poorly-made shoes or orthotics
• Performing extreme or extended exercises
• Allowing insufficient recovery time after exercise
• Conducting physical training on uneven surfaces
• Wearing high heels or rigid heels
• Stomping the foot
• Landing hard on the feet from a jump

Tips to help prevent cuboid syndrome include:

• Avoiding forceful stomping on hard surfaces, especially when wearing rigid heels or high-heeled shoes.
• Limiting forceful stomping activities in general.
• Performing cool-down and gentle stretching exercises following high-level sport or dance activities.
• Limiting wearing rigid-heeled or high-heeled shoes when running, dancing, prolonged walking, or simply being active.
• Seeking advice on proper footwear.
• Discussing your job with a physical therapist. They can analyze your job tasks and offer suggestions to reduce your risk of injury.
• Keeping your muscles strong and flexible. Participate in regular physical activity. This helps maintain a healthy weight and fitness level.

To help prevent a return of cuboid syndrome, follow the above advice, and:

• Continue your prescribed foot exercises to maintain your improvements.
• Continue to do any other home exercises you learned to help maintain strength and flexibility.
• Continue to be physically active and stay fit.

What Kind of Physical Therapist Do I Need?

All physical therapists are prepared through education and experience to treat people who have this condition. You may want to consider: 

• A physical therapist who is experienced in treating people with orthopedic, or musculoskeletal (muscle, bone, and joint) problems. 
• A physical therapist who is a board-certified clinical specialist or who completed a residency or fellowship in orthopedic or sports physical therapy. This physical therapist has advanced knowledge, experience, and skills that may apply to your condition.

You can search for physical therapists with specific experience or expertise using the American Physical Therapy Association’s Find a PT tool.

General tips when you're looking for a physical therapist:

• Get recommendations from family and friends or from other health care providers.
• When you contact a physical therapy clinic for an appointment, ask about the physical therapists’ experience in helping people with this condition.
• Be prepared to describe your symptoms in as much detail as possible and say what makes your symptoms worse.