Cuboid Fractures

Definition

• Fracture of the cuboid bone

Aetiology

• Direct compression from trauma 
• Avulsion injury (usually hindfoot inverted and forefoot adducted) – can involve any ligaments attaching to the cuboid 
• “Nutcracker” fracture (plantarflexion of hind/midfoot w abduction of forefoot)

Epidemiology

• Less common than other tarsal bone fractures 
• Very rare to have an isolated cuboid fracture. Often cuboid fractures occur in conjunction with other fractures/dislocations i.e. Lisfranc or chopart fractures

Anatomy of the cuboid

• Lateral tarsal bone 
• Despite not being a weight-bearing bone, it is very important for foot biomechanics – forms part of the lateral column
• Articulates with the 4^th and 5^th metatarsals, the lateral cuneiform, the navicular bone and the calcaneus 

Image showing the anatomy of the foot. Source: Source: https://www.ncbi.nlm.nih.gov/books/NBK547675/figure/article-32577.image.f1/

Classification systems

• No clinical classification system is commonly used
• In research predominantly the following is used

Group	Description
A	Extraarticular fracture
B	Single articular (calcaneocuboid OR metatarsocuboid)
C	Multiarticular (both calcaneocuboid and metatarsocuboid)

History

• Oedema
• Bruising
• Antalgic limp
• Refusal to weight-bear 
• Lateral foot pain particularly on the take off 

Examinations

• Pain to palpation
• Antalgic gait

Investigations

• XRays – lateral oblique/medial oblique (allows view of cuboid and its articulation w metatarsals), lateral, AP + weightbearing 
• Contralateral XRays are very important especially in the preoperative planning stage – for identifying length of the lateral column
• CT for further characterisation of fracture
• MRI

Differential Diagnosis 

• Cuboid syndrome 
• Ankle sprain
• Fracture of 5^th metatarsal 
• Lisfranc fracture
• Peroneal tendonitis
• Lateral plantar nerve entrapment

Treatment 

• Cortical avulsion fractures – Weight bear as tolerated in a CAM boot. Follow up until asymptomatic to monitor for instability 
• Undisplaced fractures – Non-weight bear for 4-6/52
• Compressed and intra-articular fractures or open fractures – surgery for restoration of length of lateral column (shortening >3mm typically requires surgical intervention) and maintain the articular congruency  

Surgical options

• Open reduction and internal fixation. 
  • Bone grafting, plating, screws
• K wires may be required to maintain the reduction
• External fixator (pin at 4^th/5^th metatarsal and calcaneus) may be used to restore lateral column length 
• Non-weight bear in a cast for 6/52, followed by CAM boot + Partial-weight bear. Full-weight bear usually won’t occur until at least 12 weeks post op 

Complications

• Post traumatic arthritis 
• Non-union
• Osteonecrosis 
• Late instability 
• Pronation deformity 

Prognosis 

• Favourable prognosis

References

Angoules AG, Angoules NA, Georgoudis M, Kapetanakis S. Update on diagnosis and management of cuboid fractures. World J Orthop. 2019;10(2):71-80. doi: 10.5312/wjo.v10.i2.71

Melvin JS. Cuboid fractures. OrthopaedicsOne Articles. In: OrthopaedicsOne – The Orthopaedic Knowledge Network. Created Jan 27, 2008. Last modified Jun 13, 2012. Cited 9 Dec 2021. Available from: https://www.orthopaedicsone.com/display/Main/Cuboid+fractures

Pountos I, Panteli M, Giannoudis PV. Cuboid Injuries. Indian J Orthop. 2018;52(3):297-303. doi:10.4103/ortho.IJOrtho_610_17

Author Contributions

Francesca Sasanelli, created December 2021

Reviewed by Professor Phong Tran, Head of Orthopaedic Surgery, Western Health. Last updated 10 October 2026.