The peroneus longus tendon changes direction by approximately 90 degrees at the cuboid groove (peroneal groove on the plantar surface of the cuboid), passing from the lateral ankle to cross the plantar foot obliquely to reach the medial cuneiform and first metatarsal base. The cuboid groove forms a fibro-osseous tunnel for the tendon, maintained by the long plantar ligament (plantar calcaneocuboid ligament), creating the plantar peroneal tunnel. The os peroneum (sesamoid) within the tendon in this region is present in approximately 26% of individuals.
The peroneus longus at the cuboid tunnel is a recognised but less common site of peroneus longus pathology — peroneus longus tendinopathy in the plantar tunnel (cuboid syndrome, plantar peroneal tendinopathy) produces lateral plantar midfoot pain reproduced by resisted plantarflexion and inversion. Os peroneum fracture or painful os peroneum syndrome produces point tenderness at the cuboid groove. PLT rupture at the cuboid tunnel produces sudden lateral arch collapse. MRI and ultrasound identify the cuboid tunnel pathology and distinguish it from the more proximal retromalleolar peroneal tendon pathology.
Inversion ankle injury fractures the os peroneum within the peroneus longus tendon at the cuboid groove, producing lateral plantar midfoot pain and point tenderness at the cuboid peroneal groove; radiograph may show the fractured os peroneum fragments and MRI confirms the PLT integrity and any associated cuboid groove injury.
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