Cuneiform Fracture

What are the Cuneiform Bones?

The cuneiform bone is a very small group of 3 bones. The lateral, middle and medial cuneiforms sit across the midfoot. The intermediate (middle) cuneiform is a wedge-shaped dome that sits between the medial and lateral cuneiforms.

These are tightly packed and connected to the rest of the foot by some large ligaments, primarily to the 1st metatarsal. As a result, injuries to the cuneiforms are rarely isolated but commonly a secondary consequence of another injury.

It is more common to fracture or injure other structures in the midfoot with an incidence rate. This study on adult fractures concluded that cuneiform fractures make up 0.1-0.5% of all adult fractures. Other common injuries in the midfoot include:

Lisfranc Fractures
Navicular Stress Fracture
Spring Ligament Sprain
Plantar Fasciitis
Medial Cuneiform Bipartite

How Many Cuneiform bones are in the foot?

There are three cuneiform bones in the foot. These consist of the medial cuneiform, which is positioned on the foot’s inner side and is the largest of the three cuneiform bones. Next to the medial cuneiform is the intermediate cuneiform and the lateral cuneiform bone to the outside.

X-ray of a foot

Types of Cuneiform Fracture

The awareness of midfoot fractures has increased in recent times. This is due to the unusual incidence where American President Joe Biden had a cuneiform fracture. Here are the common types:

Cuneiform Avulsion Fracture

Cuneiform Avulsion Fracture occurs when the ligament or tendon detaches, pulling some bony fragments off the bone.

Non-displaced Cuneiform Fracture

A non-displaced cuneiform fracture occurs when the bone remains intact and usually recovers with conservative treatment

Medial & Lateral Cuneiform Fractures

Middle Cuneiform Stress Fracture – This type of hairline fracture of the cuneiform bone. It can be challenging to detect on x-ray, and an MRI is often required.

Lateral cuneiform Fracture – this is an uncommon site of injury.

Medial Cuneiform Fracture

What causes Cuneiform Fractures

Cuneiform fractures are rare, and there is little evidence or case studies about them in the current literature. They are most often seen in high-speed incidents or as a result of overuse. Here are some causes from case studies.

Road Traffic Accident
Skiing
Skate Boarding
Running

How long does it take a cuneiform fracture to heal?

A cuneiform fracture takes 6-12 weeks to heal. Initially, a cuneiform fracture is placed in a walker boot for 4-6 weeks. In the first instance, this is non-weight bearing and progresses to weight-bearing.

Once the walker boot is removed, a period of Physical Therapy for 4-8 weeks commences. This protocol is not the case for all cuneiform fractures, and we advise seeing a Foot and Ankle Orthopedic Consultant for their opinion if you have a cuneiform fracture.

Picture of sprained ankle in a air cast boot

Can you walk on a cuneiform fracture?

When wearing an air cast walker boot, you can walk on a cuneiform fracture. It is not advised to walk barefoot with a cuneiform fracture.

Can you get a cuneiform fracture from running?

Yes. Impact activities such as running can cause cuneiform fractures.

Physiotherapy with James McCormack

This is not medical advice. We recommend a consultation with a medical professional such as James McCormack. He offers Online Physiotherapy Appointments for £45.