Cuneiform fracture
A rare foot fracture often requiring advanced imaging for diagnosis.
A cuneiform fracture involves a break in one or more of the three cuneiform bones in the foot. For context, cuboid fractures occur at a rate of 1.8 per 100,000 people each year. Although cuneiform fractures are uncommon, the medial cuneiform is the one most often affected.
People with an acute cuneiform fracture usually feel intense pain on the top or top-inner side of the foot. They struggle to walk on their toes or put weight on the foot. Swelling, tenderness, and bruising typically appear in the area between the Lisfranc and Chopart joints.
The usual cause is a direct blow to the cuneiform bones, an avulsion injury, or an axial load. Stress reactions that worsen with continued weight-bearing and activity can also lead to a fracture.
Diagnosis can be tricky because the midfoot’s overlapping joints often hide these fractures on standard X-rays. CT or MRI scans may be needed to confirm the injury.
For treatment, dislocated cuneiform bones require careful reduction, followed by choosing the right internal fixation. Nondisplaced fractures generally heal well with casting, while displaced ones usually need open reduction and internal fixation with screws. K-wires can temporarily hold isolated dislocations or fracture-dislocations and are typically removed after six weeks.
- annual incidence
- 1.8 per 100,000 population (cuboid fracture)
- most commonly fractured cuneiform
- medial cuneiform
- common cause
- physical trauma (direct blow), avulsion fracture, axial load, or stress reaction
- diagnosis difficulty
- can be invisible on plain films; may require CT or MRI
- treatment for nondisplaced fractures
- casting
- treatment for displaced fractures
- open reduction and internal fixation with screws
Lore & Background
Cuneiform fractures typically cause excruciating pain over the dorsal or dorsomedial foot, with trouble walking on toes and bearing weight. Localized ecchymosis, tenderness, and swelling appear between the Lisfranc and Chopart joints. The injury results from direct trauma, avulsion, axial load, or a stress reaction worsened by continued weight-bearing.
Reader's Guide
Diagnosis is challenging due to complex overlapping midfoot articulations, often making fractures invisible on plain X-rays. CT or MRI may be necessary. Treatment depends on displacement: nondisplaced fractures respond well to casting, while displaced fractures require open reduction and internal fixation with screws. Dislocated bones need cautious reduction, and K-wires may temporarily transfix isolated dislocations, removed after six weeks. The rarity of this injury means it is often missed, underscoring the need for careful clinical and imaging evaluation.
Did You Know?
- The annual incidence of cuboid fracture is 1.8 injuries per 100,000 population.
- The most commonly fractured cuneiform bone is the medial cuneiform.
- Cuneiform fractures can be invisible on plain films due to complex overlapping articulations.
- K-wires used for isolated dislocations are usually removed after six weeks.
More in Bone fractures 1-24
Spotted an error? Know more?
This is a living reference — every entry is fact-audited, and reader corrections feed straight into our audit queue. Suggest an edit · See this site's audit record