Diagnosing Cuneiform Fractures: How to Identify a Cuneiform Fracture

Diagnosing cuneiform fractures in the foot can be difficult. Isolated cuneiform fractures in the foot are rare, thus they are commonly missed on initial diagnosis. It’s important to diagnose these fractures early to ensure the best possible outcomes. With prompt diagnosis and proper treatment, individuals can return to normal activities.

Causes and Symptoms of Cuneiform Fractures

There are three cuneiform bones: the medial cuneiform, the intermediate cuneiform, and the lateral cuneiform.

The cuneiform bones make up the bones of the midfoot and help with shock absorption when walking.

Acute cuneiform fractures occur due to falls and direct blows to the foot. Cuneiform fractures can also occur due to twisting injuries of the foot. 

Cuneiform stress fractures occur from activities that cause repetitive stress on the midfoot. These activities include jumping, marching, and running. Athletes are at higher risk for developing stress fractures. 

Some of the symptoms of a cuneiform fracture include pain and swelling in the midfoot, bruising, inability to bear weight on the foot, decreased range of motion of the midfoot joints, and visible deformity of the foot. 

If you suspect that you have a cuneiform fracture, it’s best to stay off of your foot and RICE and contact your local foot doctor immediately. 

Diagnosis of a Cuneiform Fracture Injury

Your foot doctor will obtain a medical history and perform a physical exam. If there is pain in the midfoot, your doctor will suggest ordering imaging to confirm the presence of a fracture.

X-Ray

Your doctor will order an x-ray of your foot to determine whether there is a fracture of one or more of the cuneiform bones. An x-ray can usually be done at your doctor’s office. 

An x-ray can identify whether the fracture is nondisplaced (fracture fragments are aligned) or displaced (fracture fragments are shifted). 

An x-ray can also identify whether the fracture is intra-articular (fracture line extends into the joint) or extra-articular (fracture line does not involve the joint). An x-ray can also identify whether there is joint dislocation. 

MRI

In some cases, cuneiform fractures can be difficult to visualize on an x-ray. This is especially true in the case of cuneiform stress fractures. This is because stress fractures can take several weeks to be visible on an x-ray. 

In these cases, a Magnetic Resonance Imaging test (MRI) may be ordered. An MRI uses radio waves and a magnetic field to produce detailed images of the foot. It provides detailed images of the bones, ligaments, and tendons. It can identify the presence of cuneiform fractures as well as any sprains or tears of nearby ligaments and tendons.

In some cases, a Lisfranc ligament injury may occur when the medial cuneiform is fractured. An MRI can help identify the presence of a Lisfranc injury.

CT

If you have multiple cuneiform fractures in the foot, your doctor may order a Computed Tomography test (CT). A CT scan can identify exactly where the fractures are and show the severity of the fractures. It can provide detailed images of the fractures and the joints. CT scans are especially useful if your surgeon is planning on surgically repairing the cuneiform fracture.

Bone Scan

A bone scan may be ordered to diagnose a cuneiform fracture. During a bone scan, radioactive material is injected into a vein in the arm. This material then travels through the bloodstream and accumulates in areas of the body where there is increased bone activity. 

The accumulation of the material can be detected by a camera and used to create a 3-D image of the bones. This image can be used to help diagnose cuneiform fractures. 

Treating Foot Cuneiform Fractures

For isolated nondisplaced cuneiform fractures, immobilization for several weeks in a cast boot and rest is recommended. Nondisplaced medial cuneiform fractures that have no Lisfranc ligament injuries can be treated conservatively. 

Isolated fractures that are displaced will need surgical intervention. This is because the fractures need to be realigned to heal properly. 

After the cuneiform bone fracture heals, physical therapy will be needed for 1 month to reduce pain, increase strength, and improve balance. 

Conclusion

Cuneiform fractures of the foot should be diagnosed as soon as possible so that they can be treated appropriately. Untreated cuneiform fractures can lead to long-term complications such as arthritis, chronic pain, and instability. 

Make sure you contact your foot doctor if you suspect that you may have a midfoot fracture. 

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