Two examples of ‘cuboid syndrome’ with active bone pathology: Why did manual therapy help?

Mark Matthews, A.P. Claus

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Cuboid syndrome describes lateral midfoot pain localised to the cuboid bone. Previously reported case studies promoted joint mobilisation or manipulation interventions. The assumed mechanism was correction of a subtle disruption to the calcaneocuboid joint position. There is an absence of evidence for
correction of joint position, but there is evidence of neurophysiological mechanisms for pain modulation.
This case study reports on a patient who suffered two occurrences of cuboid syndrome on opposite feet, three years apart. With both occurrences, joint mobilisation achieved rapid and lasting resolution of severe pain and functional limitations. This occurred despite the presence of an active bone pathology at
the symptomatic cuboid (demonstrated with nuclear imaging), which could represent a stress reaction,
transient osteoporosis, ischaemic necrosis, infection or neoplasm. This case contributes three considerations for clinical reasoning and manual therapy research. 1. Active local bone pathology could exist in other patients with pain at the cuboid, and other conditions where symptoms resolve with joint
mobilisation. 2. Rapid and lasting symptom resolution fits with a hypothesis that joint mobilisation acted to reverse neurological sensitisation. 3. Lasting symptom resolution may be clinically associated with manual therapy, but mechanisms extending beyond temporary analgesia are yet to be identified.
Original languageEnglish
Article number19
Pages (from-to)494-498
Number of pages5
JournalManual Therapy
Publication statusPublished (in print/issue) - Oct 2014


  • Manual therapy
  • Mobilisation
  • Cuboid
  • Neurophysiology


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