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Cuboid Dimensions

Discussion in 'Biomechanics, Sports and Foot orthoses' started by ANDY RYALS, Apr 2, 2009.


    ANDY RYALS Member

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    I'm developing treatment protocol for ankle instability and I intend using the Cuboid to help me do this. I was wondering if there are known published dimensional sizes for the cuboid, things like average width, height, surface area etc?

    Thanks in advance

  2. MANNERS-SMITH; A study of the Cuboid and Os peroneum in the human foot.
    Journ. Anal, and Physiol. (Engl.), 1907.

    E.Stindel: 3D MR image analysis of the morphology of the rear foot: application to classification of bones
    Computerized Medical Imaging and Graphics, Volume 23, Issue 2, Pages 75-83

    http://www.nextbio.com/b/literature...&query=Navicular facet of cuboid bone&author=

    Try googling: cuboid osteometry
    Last edited: Apr 2, 2009

    ANDY RYALS Member


    Thanks for your invaluable advice, I'd like to get in contact with Bob Kidd and pick his brains regarding his work with the early skeletons.


  4. efuller

    efuller MVP

    Interesting. How is the cuboid related to ankle instability?


  5. :good: I'll bite, Eric. Through it's influence on the vectoring of the contractile force from peroneus longus and through it's articulations with the calcaneus and fifth metatarsal.
  6. LuckyLisfranc

    LuckyLisfranc Well-Known Member

    That's a genuine stretch to silly-mid-on Simon. You could sell ice cubes to eskimo's.


    ANDY RYALS Member

    I'm getting a guide together so that Pod's in our biomechanics clinic can produce differential diagnosis for lateral column pain. The cuboid is just an area that i'm interested in. As for the peroneus longus tendon, well does anyone have an idea as to the angulation of the peroneus longus in it's groove? What happens if some people have excessive angulation of the groove? Could this influence axis equilibrium ?
  8. Which is why I wrote:
    Andy, the angulation of the peroneal groove is one aspect; can you think of any more? What about it's eversion stiffness? (ice cubes anyone?)

    Not sure what axis equilibrium is. Do you mean equilibrium of moments? About which axis?
    Last edited: Apr 3, 2009
  9. How does peroneus brevis contraction influence eversion stiffness of the cuboid, if at all?
  10. Andy:

    I don't understand why you would tend to focus on the cuboid bone in order to develop a treatment protocol for ankle instability. Ankle instability is often caused by sudden and unexpected increases in subtalar joint (STJ) supination moment. This increase in STJ supination moment will then cause a STJ supination instability situation where the peroneal muscles are not activated soon enough or with enough contractile force by the central nervous system to generate sufficient STJ pronation moment to decelerate the sudden STJ supination motion.

    Knowing that the STJ spatial location often passes very close to being directly superior to the cuboid bone in the feet that have this STJ supination instability (i.e. feet with laterally deviated STJ axes), then using the cuboid as a "lever" to try and cause increased magnitudes of STJ pronation moment is the equivalent of you trying to open a door by pressing on the hinge end of the door, instead of the latch end of the door. In order to generate the maximum STJ pronation to prevent STJ supination instability, then you should be focusing your attention on the part of the plantar foot that has the greatest STJ pronation moment arm: the lateral forefoot. Hope this helps.


    Kirby KA: Methods for determination of positional variations in the subtalar joint axis. JAPMA, 77: 228-234, 1987.

    Kirby KA: Rotational equilibrium across the subtalar joint axis. JAPMA, 79: 1-14, 1989.

    Kirby KA: Foot and Lower Extremity Biomechanics: A Ten Year Collection of Precision Intricast Newsletters. Precision Intricast, Inc., Payson, Arizona, 1997.

    Kirby KA: Subtalar joint axis location and rotational equilibrium theory of foot function. JAPMA, 91:465-488, 2001.

    Kirby KA: Foot and Lower Extremity Biomechanics II: Precision Intricast Newsletters, 1997-2002. Precision Intricast, Inc., Payson, AZ, 2002.
  11. joejared

    joejared Active Member

    In your analysis, you may well wish to seperate your data sets into supinated vs pronated feet, as the longitudinal position of the cuboid will vary, more proximal in supinated feet, more distal in pronated. Back in 2002, I found this breakdown useful in identifying probable casting errors. Using the distance from the proximal edge of the heel to the center of the first metatarsal parallel to the lateral column, I found that pronated feet appeared to be greater than 49% of this length relative to the proximal edge of the heel, whereas supinated feet tended to be less than this value. When the resultant data was in conflict, as a rule, the discreprency was caused by firing upwards of the 1st or 5th toe .
  12. efuller

    efuller MVP


    I did some modeling of peroneus longus with some rigid pieces of plastic that allowed me to simulate different STJ axis positions and the ability to look at first ray plantar flexion.

    As Kevin mentioned "ankle instability" is actually more STJ instability. Feet with a more laterally positioned STJ axis will be more likely to have the ground cause a supination moment when compared to a foot with a more medially deviated STJ axis.

    What I found with modeling is that with the more medially deivated STJ axis tension in the peroneus longus tendon would cause pronation of the STJ and this would casue forefoot eversion and even though the tendon casued a plantar flexion moment of the first ray, there was a larger dodrsiflexion moment on the first ray from increased ground reaction force under the first met head, caused by STJ eversion.

    With a more average axis of the STJ, with same attachment on the first ray, pull in the simulated peroneus longus tendon caused eversion of the STJ, but the 1st metatarsal did not plantarflex or dorsiflex. This can be explained by a smaller amount of ground reaction force at the first met head.

    With a more laterally positioned STJ axis, pull on the peroneus longus caused plantar flexion of the first metataqrsal and there was supination of the STJ. The increased plantar flexion of the first ray shifted the center of pressure more medial and a more medial center of pressure of ground reaction force was able to create a greater supination moment from the ground than the eversion moment from the direct pull of the tendon.

    So, I believe that position of the STJ axis would have a lot more to do with "ankle" instabilityi than the size of the cuboid.

    Also, the plantar flexion moment of the fist ray from peroneus long tensoin is very unlikely to change much from the angulatoin of the peroneal groove. This is counter to the idea published in Normal and Abnormal function of the foot by Root Orien and Weed. The plantar flexion moment does not come from a downward pull from the tendon on the base of the metatarsal. A downward pull on the base would tend to lower the base, which in effect is dorsiflexion not plantar flexion.

    The plantar flexion moment from the pull in the tendon comes from the fact that this sets up a force couple of a rearward pull on the plantar base of the metatarsal and an anterior push from the cuneiform.

    So, the peroneus longus as it curves around the cuboid, can effect lateral instability. However, the effect on ankle instability is more from the position of the STJ axis than the shape of the cuboid or its alteration of the pull of peroneus longus.


    Eric Fuller
  13. Rob Kidd

    Rob Kidd Well-Known Member

    I have read with above with interest and feel maybe there is a need for an evolutionary perspective. The "Process Calcaneus" is a decidedly hominin feature, not present in any other primates. Its purpose has always been described as to reduce (hugely) the ROM of the CC jt. This is not in dispute; studies on the fossil record support this eg Kidd, O'Higgins & Oxnard JHE, 1996; Zipfel, DeSilva and Kidd, AJPA 2009. However, recently, my colleague Jeremy DeSilva published an important paper "Rethinknig the midtarsal break", AJPA, about now, which addresses the role of the cuboid 4-5 met jts in providing "midtarsal break" in apes. Try it! Rob Kidd.

    ANDY RYALS Member


    Lots of information for my MSc thesis when I get around to writing it! Many thanks for all the above replies. Certainly lots to think about.
  15. Freeman

    Freeman Active Member

    I don't think that in and of itself the cuboid syndrome causes instability except that those who might have it may experience weight bearing apprehension and display poor balance when walking. It may be worse with uneven surfaces...

    Does anybody have any info on how they would design an orthotic for cuboid syndrome? Any research to say that an orthotic s are proven helpful for cuboid sydrome?

    Happy Friday!
  16. Is there any scientifically verifiable evidence that "cuboid syndrome" even exists?.....I don' know of any.
  17. :good: :drinks I've been waiting to see pre and post manipulation imaging of the cuboid for many years. Very simple study.....

    Tim Harmey, you were talking to me about a study involving cuboid manipulation and imaging- there's your starting point. Show me some pictures of the cuboid position pre and post manipulation.
  18. timharmey

    timharmey Active Member

    Hi simon glad you enjoyed your rugby, I am looking at plodding from scrum to scrum for one more year.I will read these posts and get back to you( just back from holiday , trip to york).
  19. I´ll play for point of discussion.

    Do you 2 gents believe it is possible for a bone in the foot to sublux ?

    Do you believe that it is anatomically possible for the Cuboid to Sublux ?

    A lot of things we discuss have no evidence but mechanical explanations, yes a simple study and strange that it has never been completed, but I´m 99.9 % sure Cuboid syndrome exists because I´ve had it and manipulation was the only thing that reduced the pain and a new orthotic after the 2nd manipulation stopped it from returning.
  20. Mike,
    First, please define cuboid syndrome.
    Second, show me some imaging of some feet with cuboid syndrome.
    Third, show me the imaging of these feet post manipulation.

    Kevin and I talked about this one many years ago on the old podiatry mailbase. As far as I can recall no-one was able to provide this very easy to obtain evidence. It's very simple.... show me the evidence. Standardised weight-bearing views if you please.
  21. I think that what we call "cuboid syndrome" may be a dislocation of the calcaneocuboid joint labrum.

  22. Are these analogous to the synovial plica seen in the knee?
    P.S. is it a dislocation or an impingement of these infections [sic] (I presume they mean inflections).
  23. efuller

    efuller MVP

    Something happens at the calcaneo cuboid joint. I've seen some people who feel better, a lot better, after manipulation. So I'm pretty convinced that there is something to it. I like the plica or the labrum theory that makes it analogous to a torn meniscus in the knee. I wonder if we will ever know for sure. You'd have to have a clinician who knows it exists, who access to MRI with high enough resolution to distinguish a normal labrum from an abnormal labrum, whatever that abnormality might be. Then it would be nice to see a change post manipulation. I keep imagining one of my instructors, when I was a student, saying "ahhh, you don't need an MRI, just pop it back into place."

    On the other hand you don't know if it's the orthotic that did it after the second manipulation. We don't know the mechanism of injury in the first place, nor whether the modification of ground reaction force with the orthotic would prevent it.

  24. timharmey

    timharmey Active Member

    I have given the subject some thought and me repeating things I have noticed and effects I have seen without any research just leads me open to "Show me the evidence" so I will have to look in to it properly and report back in about 3 years
  25. If you would please, Tim. I think that when this study is completed and published in a good quality journal, it should make a considerable contribution and step forward in our understandings. Lets make sure the methodology is water-tight though.
  26. I'd just be happy for someone to show me that it was out of place in the first place and that the manipulation popped it back into it's rightful place in the second place. If they could show that it stayed in that place, after time walking about the place, then that should be a bonus to this place and space, in any case.... what's his face? Harmey. He seems to be on the case. I guess we'll just have to watch this space, just in case. For the record, I've never really liked drum "n" bass; I guess it's just a matter of taste. The F.O.G. live in this place, drinking a whole case and coming in, on top, and in your face. Peace and love and faith :drinks Yo, Yo, Yo, what's up MOFO? ;-) Just looted me a bag of rice. Gangggsssssttttaaaaaa.
  27. timharmey

    timharmey Active Member

    I wont/cant reply with a poem I will see if I can have a look at before and after ultrasound images before 3 years pass and let you know what I see.
  28. Attached Files:

  29. Thanks Kevin - Interesting

    True re orthotic after the 2nd.

    labrum theory put that on the list of stuff to look into whenever I get sometime.
  30. And that's the point.
  31. Dananberg

    Dananberg Active Member

    Over the years of manipulating countless cuboids, I am not sure Simon's idea of looking at pre and post x-rays will show much of anything. It is not that the visible position changes from manipulation, but rather the CC joint goes from resisting any movement to easily permitting it. It is the change in lateral column ROM which creates the pain relieving effect. Looking at pre and post ranges of motion with the patients completing a pre and post treatment VAS pain drawing would represent a far better method of assessing this process.

    On a subtly different note, I have seen many patients presenting with a previous diagnosis of "plantar fasciitis" which, on more careful evaluation, seems to actually be a spasm in the abductor hallucis muscle. Manipulating the cuboid seems to be a highly effective method in managing this situation. Pain reduction is often immediate. Not sure why this happens, but I have seen it so many times to feel quite confident that this clinical entity exists. Anyone else have this experience?

  32. It'll show whether or not the manipulation changes the position of the cuboid.

    You could include this too, although I'd want to see repeatability studies for the measurement techniques and a sham manipulation. Personally, I would measure stiffness of the lateral column, since this gets around the old how hard you pushing to create that RoM problem.

    It is my understanding that some studies using diagnostic ultrasound will be performed soon, so some dynamic imaging should be possible too.
  33. For those who use diagnostic ultrasound, shouldn't it be fairly easy to see and determine the position of the calcaneocuboid joint labrum in the "subluxed" and "non-subluxed cuboid"? Could it be possible that an irregular folding or malposition of the dorsal labrum inside the calcaneocuboid joint is what is causing the symptoms of a "subluxed cuboid" and that "cuboid manipulation" simply allows the dorsal joint to spread and allow the labrum to reposition itself correctly into the CCJ?
  34. efuller

    efuller MVP

    It's been a while since I've played with a diagnostic ultrasound machine. Back then, it was very difficult to "see" between two bones. Has the resolution gotten better?

    Last edited: Aug 16, 2011
  35. timharmey

    timharmey Active Member

    I am asking for advice , not claiming to have some great knowledge, often I would think of an" immobile cuboid" as limted movement in dorsiflexion of the 4th/5th met that on mobilisation of the cuboid leads to increased movment of 4th/5th and increased peroneal function .I think sometime that we/one is not so much mobilising the cuboid as improving peroneal function.I know /think that such random non evidience based thoughts may seem out of kilter on an academic site but hopefully we have a broad church .
  36. timharmey

    timharmey Active Member

    With regards Howard's link with plantar fasciitis /abductor hallucis spasm and cuboid manipulation; I have while trawling thru a radiology book(what an exciting life I lead) come across medial plantar neurapraxia ,entrapment of the medial plantar nerve as it passed thru the abductor hallucis muscle.The mechanism of how this is released by cuboid mobilisation I am not sure but I have noted the same presentation and resolution as Howard
  37. Rob Kidd

    Rob Kidd Well-Known Member

    Again, we need an evolutionary perspective. The processs calcaneus (aka "Beak") of the cuboid is a uniquely hominin feature. It simply does not exist in apes, apart from minutely possibly as a proto-structure - that hominins have used as a preadaptive feature. Its purpose is simply to reduce the ROM at the CC joint by possibly orders of magnitude. In the skeletal collections that I have worked on around the world, the beak is frequently eroded antemortem - this suggests that abnormal foot function causes modified morphology. I suggest that the abnormal foot function equates to a midtarsal break - the very feature of hominoid function the beak is designed to remove. Any help?

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