‘Stubborn Heel & Foot Pain – Cuboid Stress Syndrome’

Pain on the outside of the foot that can radiate into the heel is a mystery condition often experienced by people whose feet over-pronate when walking. Over-pronation means that a person’s foot rolls inwards for a longer duration than normal during the phase of walking when the heel strikes the ground. This mystery pain on the outside of the foot which can be severe in nature is known as Cuboid Stress Syndrome. The pain is felt on weight bearing movements should as running, jumping and even walking.

The Cuboid bone is located on the outside of the foot adjoining the heel bone (calcaneous bone). The peroneus Longus tendon which is situated on the outside of the ankle forms a sling around the cuboid bone. Excessive tightness in the peroneal longus tendon can serve to traction or pull the cuboid bone away from its adjoining calcaneous (heel bone). In addition, dysfunction of the calcaneocuboid joint can cause the the calcaneous bone to rotate excessive inwards thus causing strain between the two bones.

Factors that can lead to Cuboid Stress Syndrome include;

• Ankle instability

• History of sprained ankles

• Over pronating foot

• Walking / Running on uneven surfaces

• Poor footwear

• Overtraining with no post exercise stretching

• Excessive Body Weight

Signs & Symptoms

• Acute severe underneath the heel on the outside aspect of the foot. Walking and standing aggravate pain

• Tenderness when pressing the underneath surface and outside area of the ankle.

• Unable to run, jump or dance without experiencing a sharp increase in pain.

• Occasional swelling underneath heel on the outside of the foot.

• Walking with a limp in order to avoid pain

Treatment & Management

This is injury that I often diagnose in both young people and older adults who attend my clinic. Very often manipulation of the cuboid bone back into its correct position brings immediate pain relief. Deep tissue massage of the muscles that bend the foot towards the shin (dorsiflexor muscles) and the muscles that turn the ankle outwards (Peroneal tendons) should also be performed. Then a pad is placed underneath the cuboid bone of the foot alongside Low-dye strapping to give the arch of the foot more added support for 1-2 weeks.

Tomás Ryan is a Registered Physical Therapist with The Irish Association of Physical Therapy (MIAPT) and is based in Thurles. Contact Number: 0504 26672