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What is the Cuneiform Bone?

By Daniel Walker
Updated Mar 03, 2024
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In human anatomy, the cuneiform bone can refer to any of three different bones located in the top, middle portion of the foot. These three bones are called the medial, the intermediate, and the lateral cuneiform bones. Connecting the interior metatarsus bones to the navicular and cuboid bones, they are partly responsible for the arch configuration of the foot. These wedge-shaped bones take their name from their resemblance to the wedge shapes used in cuneiform writing.

The medial cuneiform is so-called because it is aligned on the inside of the foot and connects to the first metatarsal, which in turn connects to the first of the phalanges, also known as the big toe. The intermediate, or middle, cuneiform is wedge-shaped and lies between the other two bones and aligns with the second toe. The lateral, or interior, cuneiform is aligned with the bones of the third toe. Each of the bones is anchored in place by a large number of very strong ligaments.

Pain around the cuneiform bones is often associated with ligament strain or a bone injury. Any injury to these bones, if left untreated, can lead to severe pain, deformity, and loss of mobility. Often, due to swelling and the small nature of the bones, a CT scan may be the only way to determine the extent of the damage.

Injuries to the bones on the top of the feet can range from obvious, severe fractures and dislocations to hard-to-diagnose chips and ligament injuries. Minor ligament strain can often be treated by keeping weight off of the foot for an extended period. Breaks in these bones are rare, but symptoms can include general foot pain, swelling that doesn't subside after a month, and an inability of the foot to hold weight. Fractures are treated by either surgical implanting of screws or by immobilization. The bones can also be dislocated by blunt force trauma, which requires surgery to repair or remove the bone to avoid a Lisfranc joint injury.

The Lisfranc joint refers to the place where the cuneiform bones meet the metatarsals. At each bone junction, there is a joint created with ligaments holding the bones in their proper places. A Lisfranc injury is diagnosed when the the cuneiform and metatarsal bones are out of alignment at the joint due to ligament damage. The injury was first recognized by Napoleon's doctor, Jacques Lisfranc, in the 1790s, and it often occurred when a rider fell off a horse with a foot caught in the stirrups. Until the advent of modern medicine, it frequently resulted in amputation of the front of the foot; today, surgery can often correct the injury.

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