Nondisplaced cuneiform fractures, although uncommon, can occur in the midfoot. A cuneiform fracture occurs from direct trauma to one of the cuneiform bones in the foot. Isolated cuneiform bone fractures can also occur from repetitive stress on the cuneiform bones.
Fractures can either be nondisplaced or displaced.
A nondisplaced fracture is when the bone is broken but is still in place. It looks like a crack in the bone, but the pieces are still lined up. A displaced fracture is when the bone is broken and the pieces are shifted.
For this article, we’ll be discussing treatment for nondisplaced cuneiform fractures.
Causes of Cuneiform Fractures (Medial Cuneiform, Intermediate Cuneiform, and Lateral Cuneiform)
Three cuneiform bones make up the inner midfoot: the medial cuneiform, intermediate cuneiform, and lateral cuneiform.
Cuneiform fractures occur from direct trauma to the foot, inversion injuries, and falls. When cuneiform fractures occur, there are usually other foot fractures/injuries present as well.
The Lisfranc ligament attaches from the medial tarsal cuneiform into the 2nd metatarsal base. The function of the Lisfranc ligament in the foot is to prevent hyperextension of the midfoot joints and stabilize the midfoot. If a Lisfranc injury and cuneiform fracture are present, surgery may be needed.
Stress fractures of the cuneiform bone can occur due to repetitive stress to the cuneiform bones that occur over time.
Activities that can lead to the development of an isolated fracture due to stress include running, jumping, and marching.
Symptoms of a Nondisplaced Cuneiform Fracture
Symptoms of single cuneiform midfoot fractures can be vague.
Some of the common symptoms of nondisplaced cuneiform foot fractures include:
- Pain in the midfoot
- Swelling in the midfoot
- Inability to bear weight on the foot
- Visible deformity of the midfoot
- Dull, achy pain
- Pain that persists even during rest
How to Diagnose Cuneiform Fractures
If you have midfoot pain that has been present for several days, it’s important to see your local foot doctor. Your doctor will obtain a history and perform a physical exam to identify the area of your pain.
Your doctor will suggest ordering imaging to confirm the presence of a fracture.
X-rays of the foot can be obtained directly at your foot doctor’s office. Your doctor will be checking to see if there is a fracture present and whether it is displaced or non-displaced.
Your doctor will also check to see if the fracture fragments are comminuted and extend into the joint. Comminuted fractures are fractures that have more than two fragments in them. The more comminuted a fracture is, the more unstable it is.
Due to the proximity of the cuneiform bones to one another, it can sometimes be difficult to identify a fracture on a plain film x-ray. In this case, a Magnetic Resonance Imaging Scan (MRI) would be helpful.
An MRI can help identify the presence of a cuneiform fracture. It can also identify other fractures and sprains in the foot.
In certain cases, your doctor may wish to order a Computed Tomography Scan (CT scan). CT scans can help identify cuneiform fractures and also provide detailed images of the size of the fracture, the shape of the fracture fragments, as well as joint involvement. If there are multiple fractures in the foot, a CT scan is very useful.
A bone scan can be used to help identify a cuneiform fracture in the foot. The scan will show abnormalities that are present in the bone. Bone scans are particularly helpful in identifying stress fractures.
Stress fractures can take up to 3 weeks to show up on an x-ray. In a bone scan, increased radioactivity can be visible in the area of the fracture.
How to Treat a Nondisplaced Cuneiform Fracture in the Foot
Nondisplaced cuneiform fractures usually don’t require surgery. Fracture healing takes 6-8 weeks minimum. Your doctor will suggest you remain non-weight bearing in a cast for 6-8 weeks to allow the bone to heal. After which, you can transition to weight-bearing in an athletic shoe.
It can be difficult to start walking after being off your foot for several weeks. Your doctor will suggest physical therapy to help improve strength in the foot and also improve flexibility. Physical therapy can also help improve balance and reduce the chance of falls. You will need to do physical therapy for at least a month.
Full healing time after a nondisplaced cuneiform fracture will take 3 months.
Can You Walk on a Broken Cuneiform Bone?
You should not walk on a broken cuneiform bone. If you walk on a broken bone, the fracture fragments can shift and the break will become worse. If a cuneiform fracture worsens, surgery will be required to fix it.
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