A cuneiform fracture is a break in one of the three cuneiform bones, medial, intermediate, or lateral, in the midfoot. These bones help form the arch of the foot and serve as a bridge between the rearfoot and forefoot. Cuneiform fractures are rare and often occur alongside other foot injuries. Accurate, rapid diagnosis and appropriate treatment are important to maintain foot alignment and avoid long-term problems.
Types of Cuneiform Fractures and Mechanism of Injury
Cuneiform fractures typically occur as part of a midfoot injury, such as a Lisfranc injury or crush event. They may be:
- Isolated fractures, usually from direct trauma
- Avulsion fractures, where a small bone fragment is pulled off by a tendon or ligament
- Stress fractures, which may develop gradually from repetitive activity
Fractures can be non-displaced (stable) or displaced; some fractures may impact stability and joint alignment.
The Mechanism of Injury for Most Cuneiform Fractures
Cuneiform fractures most often occur due to:
- Direct trauma, for example, a heavy object falling on the foot
- Crush injuries, particularly in high-impact accidents or workplace incidents
- Twisting or midfoot compression injuries, often seen in sports
- Overuse, particularly in athletes, dancers, or runners (in stress fractures)
The Symptoms of a Cuneiform Fracture
Symptoms may be subtle or significant, depending on the injury:
- Midfoot pain, especially with standing or walking
- Localised swelling or bruising
- Tenderness over the top or inner side of the midfoot
- Pain when pushing off the foot or climbing stairs
- Difficulty bearing weight or limping
Pain may develop gradually in stress fractures or present suddenly with trauma.
Diagnosis of a Cuneiform Fracture
Diagnosis starts with a clinical assessment and may require advanced imaging due to the location of the bones:
- X-rays may identify clear fractures, but small or non-displaced injuries can be missed
- CT scans provide more detail for joint involvement or complex fractures
- MRI may be used for detecting stress fractures or associated soft tissue injuries
Accurate diagnosis is key to preventing misalignment and ensuring proper healing.
Access Ortho have medical staff who specialise in orthopaedic injuries, ensuring you receive an accurate diagnosis and treatment plan.
Treatment Approaches for a Cuneiform Fracture
Treatment depends on the cause, type and stability of the fracture:
- Non-displaced fractures may be treated with a moon boot or cast, with a period of modified weight-bearing
- Displaced or unstable fractures may require surgical fixation
- Stress fractures require rest and activity modification, with gradual return to loading
Rehabilitation may be needed to restore strength, mobility, and function in the midfoot.
The orthopaedic team at Access Ortho in our Brisbane and Ipswich clinics will discuss the best treatment for your injury.
Prognosis for a Cuneiform Fracture
With appropriate treatment, most cuneiform fractures heal well. Prognosis is influenced by:
- Early diagnosis and correct treatment
- The presence of associated injuries, such as Lisfranc disruption
- Compliance with weight-bearing restrictions and rehabilitation
If left untreated or misdiagnosed, complications such as chronic pain, midfoot instability, or arch collapse may occur.
Access Ortho offers rapid appointments for acute orthopaedic injuries.
Role of Access Ortho in Diagnosing and Treating Cuneiform Fractures
At Access Ortho, we provide rapid, orthopaedic care for midfoot injuries, including cuneiform fractures. Our experienced Nurse Practitioners and Orthopaedic Surgeons work together to:
- Perform same-day clinical assessment
- Refer for X-rays, CT or MRI when further evaluation is needed
- Provide moon boots, crutches, and pain management during your visit
- Offer ongoing follow-up with orthopaedic specialists
If you’ve injured your foot, Access Ortho is here to help — no referral necessary.