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Cuneiform Stress Fractures: Causes, Symptoms, Diagnosis & Treatment

Cuneiform stress fractures are rare injuries. They can occur from too much stress being placed on the midfoot. Symptoms of cuneiform fractures include midfoot pain and swelling. 

Cuneiform stress fractures are treated using rest and immobilization. In this article, we’ll discuss the causes, symptoms, and treatment for cuneiform fractures. 

What Are the Cuneiform Bones?

There are three cuneiform bones in the foot: the medial cuneiform, the middle cuneiform, and the lateral cuneiform. 

The cuneiform bones are wedge-shaped bones that make up the inner midfoot. They help with shock absorption and aid with stability when walking and running. 

The cuneiform bones are held tightly together with ligaments. The cuneiform bones articulate with the metatarsal bones and the navicular bone. 

Causes of Cuneiform Stress Fractures

Cuneiform stress fractures occur secondary to overuse. Activities that cause strong repetitive “push-off” forces in the foot can also cause stress fractures. 

Activities such as jumping, running, and marching can cause excess stress to be placed on the midfoot. This can cause the bone to fatigue and then crack. 

Wearing unsupportive shoes and training improperly can also lead to cuneiform stress fractures.

top of foot pain

Symptoms of Stress-Related Cuneiform Fractures

Stress fracture symptoms can be vague. Unlike acute fractures, the bone gets fatigued over time. Initially, you may notice initial dull and achy pain in the foot. This pain generally worsens the more you walk on it. 

Other symptoms of cuneiform stress fractures include: 

  • Swelling in the foot
  • Bruising in the foot
  • Inability to bear weight on the foot
  • Pain in the midfoot that is present when walking and persists when resting
  • Limping (Limping may be the first symptom seen in children)

How to Diagnose a Foot Cuneiform Fracture

If you think that you may have a cuneiform foot fracture, you should be evaluated by a foot doctor. 

Your doctor will perform a physical exam of the foot and localize the area of pain. If one or more cuneiform bones are broken, there will be pain and swelling present in the midfoot. Your doctor will press on the medial cuneiform bone, middle cuneiform bone, and lateral cuneiform bone to determine which bone(s) is causing the foot pain. 

Your doctor will order an x-ray of the foot to confirm the presence of a cuneiform fracture. Keep in mind that stress fractures can take 3 weeks to show up on an x-ray. Unlike acute fractures, the crack in the bone can appear subtle.

If the fracture is not visible and your doctor suspects that you have a stress fracture, he/she will order a Magnetic Resonance Imaging test (MRI) or Computed Tomography Test (CT scan) to diagnose the stress fracture. 

These studies will show detailed images of the bone, joint spaces, and soft tissue structures that are damaged. They provide the doctor with more details on the actual fracture pattern.  

Bone scans can also help identify early stress fractures in the foot. All of these tests are non-invasive and useful in identifying foot fractures. 

How to Treat a Cuneiform Stress Fracture

If the cuneiform stress fracture is nondisplaced, meaning that the fragments are broken but remain in proper alignment, immobilization is needed. You will need to stay non-weight-bearing in a cast boot or splint for 6 to 8 weeks until it heals. 

If the fracture fragments are shifted (in the case of a displaced cuneiform fracture) your doctor will recommend surgery to realign the fragments. In this case, you will need to stay off of your foot for 6-8 weeks followed by walking in a cast boot for 1 month before transitioning to athletic shoes. 

How Long Does It Take for a Cuneiform Stress Fracture to Heal?

Nondisplaced stress fractures will heal in 6-8 weeks in most cases. Displaced stress fractures that require surgery will heal in 8-12 weeks. Full recovery from a displaced cuneiform stress fracture could take 3 months or more. 

Can You Walk on a Cuneiform Fracture?

You should not walk barefoot with a cuneiform stress fracture. This can cause the fracture fragments to shift. This will worsen the injury. 

Can You Get a Cuneiform Fracture From Running?

Cuneiform stress injuries can occur from running. Any activity that causes repetitive stress on the cuneiform bone can cause it to fracture. 

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The information, including but not limited to, text, graphics, images and other material contained on this website are for informational purposes only. No material on this site is intended to be a substitute for professional medical advice, diagnosis or treatment. Always seek the advice of your physician or other qualified health care provider with any questions you may have regarding a medical condition or treatment and before undertaking a new health care regimen, and never disregard professional medical advice or delay in seeking it because of something you have read on this website.

Vaishnavi Bawa
Dr. Vaishnavi Bawa is a Podiatrist who specializes in treating foot and ankle pathology. LifesLittleSteps mission is to educate the public about foot health in an easy-to-understand manner using evidence-based medicine.
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