About 4% of all athletes with foot problems have pain from the cuboid bone. It is often caused by excessive pronation of the feet. Ballet dancers and runners are particularly at risk for this condition.

Physical therapists can treat this problem by manipulating the cuboid bone to reposition it into its normal position. This often alleviates the pain and restores movement of the foot and ankle.

What is a cuboid notch?

A cuboid notch is a raised area on the lateral surface of an orthotic that elevates the cuboid bone. This design is to help prevent the foot sliding laterally off the foot orthotic and to support the lateral cuboid in people with foot problems such as cuboid syndrome.

The cuboid bone is a short, square-shaped bone in the lateral midfoot of the lower leg and foot. It has several articulating surfaces including a medial quadrilateral facet for articulation with the fourth metatarsal and a lateral triangular one for articulation with the fifth metatarsal. On occasion there is a smaller oval facet behind this for articulation with the navicular.

The cuboid bone can be subluxated downward (cuboid syndrome) causing pain on the outside and underside of the foot. This can occur with a high heeled shoe or walking for prolonged periods in a ‘toe-pointed’ (ballet dancer) position. Physical therapy is often aimed at repositioning and stabilising the cuboid bone.

How does a cuboid notch work?

Cuboid notches or pads can be incorporated intrinsically into the design of a foot orthotic shell or added extrinsically as a pad from materials like EVA adhered to the underside of the foot orthotic. Traditionally the cuboid notch is placed on the lateral aspect of the foot orthotic and elevates the cuboid bone to support it in conditions such as cuboid syndrome or calcaneo-cuboid fault syndrome.

The cuboid bone has several articulating surfaces including two broad medial quadrilateral facets that articulate with the fourth and fifth metatarsal bones and a large lateral triangular facet for articulation with the fifth metatarsal bone. It also possesses a small oval facet on the dorsal surface for articulation with the navicular bone and the rest of the dorsal surface is rough for attachment of strong interosseous ligaments. The cuboid notch takes pressure off the cuboid bone and can help to prevent it dropping in a plantar direction (everting) as part of the calcaneo-cuboid joint motion that occurs with oversupination.

Why is a cuboid notch in a foot orthotic important?

A physical therapist will use their hands to reposition and stabilize the cuboid bone in its normal position. This will reduce or eliminate pain and restore your ability to stand and walk.

Cuboid syndrome is characterized by sharp pain on the outer side (and sometimes underside) of the foot that becomes worse when walking. It may occur suddenly due to an ankle sprain that affects the cuboid bone or it can develop slowly over time from repetitive tension through the peroneal tendon.

This injury often occurs in ballet dancers who stay in a toe-pointed position for long periods of time or in runners and basketball players who put repetitive stress on their feet. It can also be caused by sudden trauma like landing hard on the feet or by wearing rigid shoes. A cuboid notch or pad can be incorporated intrinsically into the orthotic shell or added extrinsically as a separate piece of material on top of the foot orthotic.

What are the differences between a cuboid notch and a cuboid pad?

The cuboid bone has a square shape and is located in the lateral mid foot. It has several articular surfaces for interaction with other bones, including the navicular bone. The navicular is a small bone with a triangular proximal surface and a large oval facet for articulation with the fourth and fifth metatarsal. It is found in about a quarter of normal feet and has been implicated in over-pronated feet. The cuboid can be subluxated downward in a condition called cuboid syndrome, which leads to a swollen and painful area of the outside of the foot.

Your physical therapist or podiatrist can use manual therapy techniques to reposition the cuboid bone back to its normal position and help you walk normally again. They will also teach you exercises and a treatment plan to do at home that will speed your recovery and return you to your normal life activities as soon as possible. They may also recommend a foot orthotic with a cuboid notch or pad. These pads are designed to mitigate oversupination in the foot and reduce stress on the cuboid bone. They can be incorporated intrinsically in the orthotic shell or added extrinsically as a cuboid pad from materials like EVA adhered to the foot orthotic.