Today, we're going to talk about the cuboid bone: it's something runners need to learn about. We all know that runners’ feet take a regular beating. All those miles we log can take a toll on the health of our feet, and, when those feet start to hurt, it’s not always easy to make them feel good again (especially if we are guilty of pushing through the pain). There are many different ways to hurt your feet running—you can strain your plantar fascia, leaving you with heel pain. You could step funny and twist your ankle. And you can develop a stress fracture from repetitive impact on the same spot.

Don’t you love having options? All joking aside, foot injuries can kill your runs! So, today, I’ll explain one foot injury that runners often develop—but are not so quick to identify and treat—an injury to the cuboid bone!

Hold On: What is a Cuboid Bone?   Though small, the cuboid bone can cause big problems for runners

If you haven’t heard of this particular bone, don’t worry. You’re not alone. The cuboid bone is small. It’s shaped like a wedge and it sits on the outside of your foot (see the diagram on the right).  

Its cubical body also has a boney profile. (It's called the tuberosity of the cuboid. And it sticks out of the bone, pointing towards the sole of your foot.) 

But don’t let the cuboid’s size fool you—it’s got a big job! The cuboid bone supports the outside of your foot; it’s crucial to every move you make. It serves as an attachment point for some of your foot muscles. It acts as a pulley system where your foot meets your ankle, letting you flex your foot downwards. And it also helps support the outer column of your foot. This is what makes it possible for you to stand and balance. 

Sounds like a lot of work, doesn't it? Especially for such a small bone? Well, that's because it is! Which is why, if you’ve irritated or injured your cuboid, you're in trouble. Because now, running, walking or, really any movement at all will not feel great.

What injures the cuboid bone?

As it turns out, there are a bunch of different ways to bother your cuboid bone. They include, but aren’t limited to:

  • Faulty biomechanics (when your natural gait is not optimal, due to the physical makeup of your body)
  • Stepping on something hard
     
  • Dropping something heavy on your foot. (In this case, you'd probably break your cuboid and another foot bone. And you may hear your injury referred to as a nutcracker fracture. But, helpful tip: your podiatrist won't be talking about the ballet. Just about your fractured cuboid and mid-foot bones.) 
  • Spraining your ankle
  • Restricted movement in your ankle
  • Uneven weight distribution in your body.
     
  • Cuboid syndrome. (This is a rare condition where the bone partially dislocates. It's usually caused by an ankle sprain. Or by feet that pronate too much, which means they roll inward when you move.) 
     
  • Car accidents may lead to cuboid injuries, especially if compression is involved. 

Any one of these factors can cause your cuboid bone to drop down, restricting its ability to move with your foot.

 

What are the symptoms of a cuboid injury?

If your cuboid bone is injured, your foot won’t splay well. So it will be hard for your to spread your toes. But the problems don't stop there.

When you can't splay your toes, walking and running become extremely painful. That's because an un-splayed foot doesn’t absorb shock very well. Which is why, if you have a cuboid injury, you may also feel like you stepped on something, even if you haven’t.

Of course, those aren't the only symptoms of a cuboid injury. As with most other foot injuries, you'll also notice bruising and swelling. And your foot's range of motion may be limited. Even beyond the limits of your toe movements. 

Diagnostic Challenges

If this tiny bone is the source of your pain, getting the right diagnosis can be tricky. In fact, researchers studying cuboid injuries say it's hard to detect. For that reason, they now recommend several different diagnostic layers, to avoid missing your injury. These include: 

  • A detailed physical examination
  • X-rays
  • Magentic resonance imaging (MRI) 

Often, we can't detect a cuboid fracture on a traditional x-ray. And that's why this study suggests a follow up MRI if x-rays don't explain why you're experiencing pain on the outside of your foot. 

 

Treating a cuboid injury Even if you break your cuboid bone, you shouldn't be in a cast for too long

Before we can treat your cuboid injury, we have to figure out why you got hurt. So, the first line of defense for a cuboid injury should be a gait analysis. That way, we can see if your biomechanics are triggering the pain. And, if your bone isn't broken, custom orthotics may also help take pressure off the bone, making it possible to run again.

And, as with any runners’ foot injury, you should always see your podiatrist to make sure you aren’t dealing with a stress fracture in the cuboid or any other foot or ankle bone. You may need an MRI to see if your bone is broken, as I just mentioned. Then, if we do find a fracture, we'll take the weight off your foot with a cast or walking boot. 

Now, immobilization only works if your fracture isn't displaced. Because, if the bones moved, we'll have to recommend surgery. Otherwise, your foot won't heal properly. And your mobility could be compromised for good. 

Luckily, even if you need an operation, the cuboid heals quickly. That's because it's got a good blood supply. (Unlike your fifth metatarsal bone. Which is why Jones' fractures take forever to heal. And are notorious sports injuries.)  So, even with a broken cuboid, you'll likely get back to running in a relatively short time frame. 

Of course, it's still better to address cuboid pain early on. Having pain when you're running? Whether it's your cuboid bone or something else, come in today, so we can keep you running without pain. Contact Houston podiatrist Dr. Andrew Schneider for an immediate appointment.

 

Dr. Andrew Schneider
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A podiatrist and foot surgeon in Houston, TX.
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