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Calcaneal process of cuboid bone

The calcaneal process of the cuboid is the posterior projection of the cuboid bone, located at its junction with the calcaneus. It contributes to the calcaneocuboid joint, an essential stabilizer of the lateral longitudinal arch of the foot. This process provides attachment sites for important ligaments and forms a pulley surface for the peroneus longus tendon.

Fractures or ligamentous injuries involving this region can significantly impair midfoot stability and gait mechanics. Because of its small size and complex anatomy, MRI and CT are often required for accurate evaluation.

Joints

  • Forms the calcaneocuboid joint with the anterior process of the calcaneus

  • Contributes to the transverse tarsal joint (Chopart’s joint)

Ligament Attachments

  • Long plantar ligament: Attaches to plantar surface of calcaneal process, forming a tunnel for peroneus longus tendon

  • Short plantar ligament (plantar calcaneocuboid): Anchors calcaneus to cuboid at this region

  • Bifurcate ligament (calcaneocuboid part): Attaches dorsally, stabilizing calcaneocuboid articulation

Tendon and Muscle Relations

  • Peroneus longus tendon: Runs through a groove on the plantar surface of cuboid, supported by long plantar ligament forming a fibrous tunnel

  • Flexor hallucis brevis: Originates partly from plantar surface near the process

  • Tibialis posterior tendon: Inserts partly into cuboid near calcaneal process among other midfoot sites

Nerve Supply

  • Lateral plantar nerve (branch of tibial nerve): Supplies plantar ligaments and surrounding joint capsule

  • Deep peroneal nerve: Provides articular fibers to calcaneocuboid joint

Arterial Supply

  • Lateral plantar artery: Plantar branches supply calcaneocuboid region

  • Dorsalis pedis (via arcuate artery branches): Contributes dorsally

  • Peroneal artery branches: Provide collateral supply

Venous Drainage

  • Drains into lateral plantar vein, dorsal venous arch, and peroneal veins

Function

  • Contributes to stability of the calcaneocuboid joint

  • Acts as pulley for peroneus longus tendon, supporting lateral longitudinal arch

  • Provides ligamentous anchorage for long and short plantar ligaments

  • Plays a key role in foot mechanics during push-off phase of gait

Clinical Significance

  • Fractures: Avulsion or stress fractures can destabilize lateral arch

  • Ligamentous injury: Damage to long plantar or short plantar ligaments may compromise peroneus longus tendon mechanics

  • Peroneus longus pathology: Tendinopathy or subluxation may involve cuboid pulley

  • Cuboid syndrome: Involves pain and instability at calcaneocuboid joint, sometimes linked to this process

  • Imaging role: MRI/CT useful for detecting fractures, ligament injuries, or tendon pathology

MRI Appearance

  • T1-weighted images:

    • Calcaneal process marrow: intermediate-to-high signal depending on fat content

    • Cortical bone: low-signal rim (dark)

    • Fracture: linear low-signal line disrupting normal contour

  • T2-weighted images:

    • Marrow: intermediate-to-high signal depending on fat composition

    • Cortical bone: dark low-signal margin

    • Fracture or stress reaction: bright hyperintense line with surrounding edema

  • STIR:

    • Normal: marrow suppressed (dark)

    • Pathology: hyperintense signal indicating marrow edema, fracture, or ligament injury

  • Proton Density Fat-Saturated (PD FS):

    • Normal: homogeneous low-to-intermediate signal

    • Pathology: bright hyperintense signal in fractures, stress reaction, or ligamentous injuries

  • T1 Fat-Sat Post-Contrast:

    • Normal: minimal enhancement

    • Pathology: enhancement around fractures or inflamed ligaments/tendons

MRI Arthrogram Appearance

  • Contrast outlines calcaneocuboid joint space

  • Ligament tears or joint capsule defects: Contrast extravasation into adjacent soft tissues

  • Cartilage defects: Contrast pooling along cuboid articular surface

CT Appearance

Non-Contrast CT:

  • Excellent cortical bone definition

  • Fractures: sharply delineated cortical breaks

  • Sclerosis: chronic changes visible with high-density margins

  • Cortical bone: very high density, sharply outlined

  • Marrow: trabecular architecture clearly visualized

CT Arthrogram Appearance

  • Contrast outlines calcaneocuboid joint

  • Articular cartilage defects: contrast extends into subchondral clefts

  • Ligament injuries: contrast leak into soft tissues or along ligament plane

  • Particularly useful in patients unable to undergo MRI

CT VRT 3D image

Calcaneal process of cuboid bone 3d

MRI image

Calcaneal process of cuboid bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

Calcaneal process of cuboid bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001