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Cuboid and cuneiform fractures

Anthony Beutler, MD
Cole Taylor, MD
Shane L Larson, MD
Section Editor
Patrice Eiff, MD
Deputy Editor
Jonathan Grayzel, MD, FAAEM


The cuboid acts as a static supporting structure within the lateral column of the foot. The medial, intermediate, and lateral cuneiform bones (sometimes referred to as the first, second, and third cuneiforms, respectively) serve as stabilizing structures within the medial column of the foot. While cuboid and cuneiform fractures are uncommon, they can result in significant short- and long-term pain and dysfunction, particularly if they are missed or mismanaged.

The presentation, diagnosis, and nonoperative management of cuboid fractures will be reviewed here. Other foot injuries and conditions are discussed separately. (See "Evaluation and diagnosis of common causes of foot pain in adults" and "Foot and ankle pain in the active child or skeletally immature adolescent: Evaluation" and "Proximal fifth metatarsal fractures" and "Tarsometatarsal (Lisfranc) joint complex injuries" and "Calcaneus fractures".)


Cuboid fractures are uncommon. According to one retrospective case series, the annual incidence of cuboid fracture is 1.8 injuries per 100,000 population [1]. Epidemiologic studies report mixed findings: some describe a unimodal distribution affecting predominantly young men, while others describe a higher incidence among older women [1,2]. Cuboid fractures are frequently associated with other fractures, dislocations, or ligament injuries and may result in considerable long-term disability. Particularly in high-energy trauma (eg, motor vehicle collision), cuboid fractures may occur in association with several additional tarsal fractures, and complex articular dislocations [3].

Isolated fractures of the cuneiform bones are rare, and even since the development of advanced diagnostic imaging techniques reports of isolated fractures remain scarce. Thus, there is insufficient epidemiologic data to define the occurrence rate of cuneiform fractures [4]. Based on data from a population of adult industrial workers, the estimated incidence may range from 0.1 to 0.5 percent of all fractures [5]. As with other midfoot fractures, particularly those stemming from high-energy trauma, cuneiform fractures are frequently associated with other tarsal fractures, dislocations, or ligament injuries, which may result in considerable long-term disability. As is the case with other tarsal fractures, subtle cuneiform fractures can easily be missed on radiograph and diagnosis delayed [6,7].


Foot anatomy is discussed in detail separately. Features of particular relevance to cuboid and cuneiform fractures are described below. (See "Evaluation and diagnosis of common causes of foot pain in adults", section on 'Anatomy and biomechanics'.)


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Literature review current through: Sep 2016. | This topic last updated: Aug 17, 2016.
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