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Cuboid

The cuboid is a cube-shaped tarsal bone located on the lateral side of the midfoot. It articulates posteriorly with the calcaneus, medially with the lateral cuneiform and navicular, and anteriorly with the bases of the 4th and 5th metatarsals. It plays a crucial role in lateral foot stability, load transmission, and the integrity of the lateral longitudinal arch.

The cuboid serves as a keystone for the lateral column of the foot and is also notable for the peroneal sulcus on its plantar surface, which houses the tendon of the fibularis longus. Injuries of the cuboid, including fractures and subluxations, may compromise foot biomechanics and lead to chronic lateral foot pain.

Joints

  • Calcaneocuboid joint: Posterior articulation with calcaneus (part of Chopart’s joint)

  • Tarsometatarsal joints: Anterior articulation with bases of 4th and 5th metatarsals

  • Intertarsal articulations: Medial articulation with lateral cuneiform and navicular

Ligament Attachments

  • Dorsal calcaneocuboid ligament

  • Plantar calcaneocuboid ligament (short plantar ligament)

  • Long plantar ligament – extends from calcaneus to cuboid, forming tunnel for fibularis longus tendon

  • Interosseous ligaments with adjacent tarsals and metatarsals

Tendon and Muscle Relations

  • Plantar surface: Fibularis (peroneus) longus tendon passes through the cuboid groove (peroneal sulcus)

  • Dorsal surface: Extensor digitorum longus tendons pass nearby en route to metatarsals

  • Muscular relations: Tibialis posterior attaches partly to cuboid via slips; flexor hallucis brevis originates partially from cuboid plantar surface

Nerve Supply

  • Lateral plantar nerve (branch of tibial nerve): Supplies plantar aspect of joints and ligaments around cuboid

  • Deep peroneal nerve: Contributes to dorsal joint capsule innervation

Arterial Supply

  • Lateral plantar artery: Plantar surface

  • Dorsalis pedis artery branches: Dorsal cuboid and tarsal branches

  • Peroneal artery branches: Lateral aspect

Venous Drainage

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

Function

  • Structural support: Keystone of the lateral longitudinal arch

  • Load transfer: Transmits forces from hindfoot to forefoot

  • Tendon pulley: Fibularis longus tendon uses cuboid groove as a pulley to support transverse arch

  • Joint stability: Stabilizes calcaneocuboid and tarsometatarsal joints

Clinical Significance

  • Fractures: Common in midfoot trauma, “nutcracker” cuboid fracture from axial load

  • Subluxation: Cuboid syndrome (subluxation or malalignment causing lateral foot pain)

  • Overuse injuries: Stress fractures and degenerative changes in athletes

  • Surgical relevance: Restoring cuboid alignment is essential for lateral column length and foot function

MRI Appearance

  • T1-weighted images:

    • Normal cuboid marrow: intermediate-to-high signal depending on fat content

    • Cortical bone: uniform low signal (dark rim)

    • Fractures: linear low-signal clefts

    • Bone marrow edema: diffuse low signal replacing fat

  • T2-weighted images:

    • Normal marrow: intermediate-to-high signal based on fat content

    • Cortical bone: dark low signal

    • Bone marrow edema and fractures: bright hyperintense regions

    • Cartilage surface: hyperintense outlining joint articulations

  • STIR:

    • Normal marrow: suppressed dark

    • Edema, fractures, cysts: bright hyperintense signal

  • Proton Density Fat-Saturated (PD FS):

    • Normal: low-to-intermediate signal marrow with cortical rim dark

    • Pathology: bright signal intensity in stress fractures, bone bruises, degenerative change

  • T1 Fat-Sat Post-Contrast:

    • Normal: homogeneous enhancement of marrow

    • Pathology: areas of absent enhancement in necrosis or irregular enhancement in fractures/osteomyelitis

MRI Arthrogram Appearance

  • Contrast outlines calcaneocuboid and tarsometatarsal joint surfaces

  • Cartilage defects: contrast pools into subchondral defects

  • Helps detect subtle chondral injury or osteochondral lesions in cuboid

CT Appearance

Non-Contrast CT:

  • Excellent for cortical bone visualization

  • Cortical bone: high-density rim, sharply delineated

  • Fractures: clear cortical disruption or comminution

  • Stress fractures: subtle cortical thickening or trabecular irregularity

  • Degenerative change: sclerosis, cysts, and osteophytes

CT Arthrogram Appearance

  • Contrast outlines articular surfaces of cuboid with calcaneus, navicular, and metatarsals

  • Linear contrast clefts = intra-articular fractures or chondral defects

  • Superior to plain CT for cartilage evaluation

CT VRT 3D image

Cuboid bone ct 3d

MRI image

Cuboid bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000

MRI image

Cuboid bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00001

MRI image

Cuboid bone MRI axial cross sectional anatomy 3T MRI AI enhanced radiology image-img-00000-00000_00002

CT image

Cuboid bone sagittal CT cross sectional anatomy radiology image-img-00000-00000