Home > Foot/Ankle Injury > Cuboid Subluxation and Lateral Ankle Sprains

Cuboid Subluxation and Lateral Ankle Sprains

In the article entitled “Cuboid subluxtion: a case study and review of the literature” by Adams & Madden they describe the potential for traumatic cuboid subluxation to occur during a plantarflexion and inversion ankle sprain.
Link to article on PubMed:

http://www.ncbi.nlm.nih.gov.libproxy.lib.unc.edu/pubmed/19904069

Mechanism of Injury: Cuboid subluxation most commonly occurs in a plantar direction (inferior displacement).  This is due to the anatomical relationship of the peroneus longus tendon that passes lateral and inferior to the cuboid as the tendon dives to it’s insertion point.  The cuboid serves as a fulcrum or pulley for the peroneus longus tendon.  Excessive tension within the peroneus longus, as would occur during a plantarflexion & inversion ankle sprain (eccentric contraction), forces the cuboid in a plantar and medial direction resulting in subluxation.

Evaluative Findings:
  • Pain in medial longitudinal arch towards, distally toward the 4th and 5th metatarsals, and proximally toward the ankle
  • Weakness and recreation of pain during toe off / push off of gait/running/jumping
  • Subtle cuboid displacement (inferior) and pain may be noted during palpation of cuboid
  • Recreation of pain during the following passive motions: combined plantarflexion, adduction, and inversion (supination)
  • Reduced plantar and dorsal gliding motion of cuboid may be present
Management:
Plantar direction cuboid subluxation must be corrected and normal bony alignment needs to be restored.  There are 2 basic techniques that can be utilized to return the cuboid to it’s normal position.
Cuboid Squeeze:  Place ankle in maximal plantarflexion.  Create a slight long axis distraction down the foot with the distal hand while simultaneous pressing the cuboid in a downward and lateral direction (“squeezing”).
Cuboid Whip: Interlock fingers over the dorsum of the foot to act as a fulcrum and position the thumbs side by side or overlapping over the plantar aspect of the cuboid.  Exert a dorsal force over the cuboid while swinging the foot into plantarflexion.  An audible pop or clunk may occur.
Taping to support the cuboid in place may also be utilized after mobilization.  The article by Adams and Madden also describes a taping procedure that can be used to facilitate cuboid support.
Additional articles on cuboid subluxations can be found at the articles listed below:

http://www.ncbi.nlm.nih.gov.libproxy.lib.unc.edu/pubmed?term=mooney%20m%20and%20cuboid

ww.jssm.org/vol5/n4/18/v5n4-18pdf.pdf

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Categories: Foot/Ankle Injury
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