The Common Vein Copyright 2010
Definition
The lateral cuneiform bone of the midfoot is characterized by being the smaller than the medial cuneiform, but larger than the intermediate cuneiform. It is also referred to as the third cuneiform.
It is part of the tarsal bones of the foot. It consists of bone and cartilage.
Its unique structural feature is that it is one of the cuneiform bones. It is shaped like a wedge. It is located between the navicular, cuboid, metatarsals (2,3,4), and the intermediate cuneiform. The lateral cuneiform articulates with the cuboid.
The lateral cuneiform’s ossification center appears during the first year of life. The cuneiforms as well as all other bones, muscles, and ligaments of the body are derived of mesodermal origin in embryo.
The function of the lateral cuneiform is to articulate with the cuboid, navicular, intermediate cuneiform, and metatarsals. It provides support for the midfoot.
Common diseases include arthritis, Lisfranc Injury, fracture, stress fracture, and osteomyelitis.
Arthritis can occur as a result of aging and use (osteoarthritis), rheumatoid arthritis, or as a result of post-traumatic changes.
A Lisfranc Injury refers to fracture/dislocation of all the joints in the midfoot due to a hyperextension injury. Compartment syndrome may occur after this type of injury.
Osteomyelitis is an infection of the bone typically due to bacteria.
Commonly used diagnostic procedures include clinical history, physical exam, plain radiographs, CT scan, bone scan, and MRI.
It is usually treated with either non-operative methods or operative methods. Fractures can be treated non-operatively or operatively. Arthritis can be treated with surgery, physical therapy, or NSAIDs. Osteomyelitis is treated with surgery and antibiotics. Lisfranc injury is treated non-operatively or operatively depending upon the level of displacement of the bones. Non-operative management is usually casting and non-weight bearing for 6 weeks. Operative treatment involves screws or k-wire fixation with subsequent non-weightbearing for 6 to 12 weeks.
References
Elstrom J, Virkus W, Pankovich (eds), Handbook of Fractures (3rd edition), McGraw Hill, New York, NY, 2006.
Koval K, Zuckerman J (eds), Handbook of Fractures (3rd edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Lieberman J (ed), AAOS Comprehensive Orthopaedic Review, American Academy of Orthopaedic Surgeons, 2008.
Moore K, Dalley A (eds), Clinically Oriented Anatomy (5th edition), Lippincott Williams & Wilkins, Philadelphia, PA, 2006.
Wheeless’ Textbook of Orthopaedics: Anatomy and Radiographs of the Midfoot (http://www.wheelessonline.com/ortho/anatomy_and_radiographs_of_the_midfoot