Copyright The Common Vein 2010
Definition
The cuboid bone of the midfoot is characterized by its cubical shape.
It is part of the distal tarsal row of the musculoskeletal system. It is the most lateral bone in the distal tarsal row. The cuboid consists of bone and cartilage.
Its unique structural features allows for five sites of articulation. The cuboid articulates with the calcaneus, the navicular, the lateral cuneiform, the 4th metatarsal, and the 5th metatarsal. The calcaneus articulation is proximal. The articulations with the lateral cuneiform and the navicular are medially. The cuboid articulation with the 4th and 5th metatarsal is distally. There is a groove for the tendon of the fibularis/peroneus longus muscle along the inferolateral surface.
The cuboid as well as all other bones, muscles, and ligaments of the body are derived of mesodermal origin in embryo.
The function of the cuboid bone is to articulate with other tarsal and metatarsal bones. It also provides stability to the lateral foot mostly through the calcaneocuboid joint.
Common diseases include direct cuboid fracture, Nutcracker Injury, stress fracture, and cuboid syndrome/subluxation.
Direct cuboid fracture is not common, but occurs when there is injury to the dorsolateral aspect of the cuboid. Side effects of improper healing of a cuboid fracture include compromise of the function of the peroneus longus tendon due to abnormal scarring and healing at the peroneal groove.
The Nutcracker Injury is a form of indirect injury to the cuboid. It occurs when there is a torsional compression of the cuboid between the calcaneus and 4th and 5th metatarsals.
A stress fracture of the cuboid can occur in athletic individuals due to bone fatigue.
Cuboid syndrome is a condition where there is subluxation of the cuboid bone resulting in lateral foot pain and occasionally can present with foot weakness. The cuboid syndrome occurs when there is direct impact or exertion typically during athletic movements such as landing from a jump or ballet dancing. The injury can be seen more common in people with generalized ligamentous laxity including Ehler’s Danlos syndrome.
Commonly used diagnostic procedures include clinical history, physical exam, plain radiographs, CT scan, bone scan, and MRI. Patients may present with pain, swelling, and tenderness over the dorsolateral part of the foot.
It is usually treated with either non-operative methods or operative methods. Non-operative indications include isolated cuboid fractures without significant displacement or ligamentous injury. A cast or removable type boot can be used for 4 to 6 weeks. Surgery is required if there is greater than 2mm of joint surface disruption or compression, or if the bone was severely comminuted.
References
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Wheeless’ Textbook of Orthopaedics: Cuboid Fracture (http://www.wheelessonline.com/ortho/cuboid_frx)