Official reprint from UpToDate®
www.uptodate.com ©2017 UpToDate, Inc. and/or its affiliates. All Rights Reserved.

Cuboid and cuneiform fractures

Anthony Beutler, MD
Cole Taylor, MD
Shane L Larson, MD
Section Editors
Patrice Eiff, MD
Chad A Asplund, MD, FACSM, MPH
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'.)

To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:

Subscribers log in here

Literature review current through: Nov 2017. | This topic last updated: Aug 17, 2016.
The content on the UpToDate website is not intended nor recommended as a substitute for medical advice, diagnosis, or treatment. Always seek the advice of your own physician or other qualified health care professional regarding any medical questions or conditions. The use of this website is governed by the UpToDate Terms of Use ©2017 UpToDate, Inc.
  1. Court-Brown CM, Zinna S, Ekrol I. Classification and epidemiology of mid-foot fractures. The Foot 2006; 16:138.
  2. Coulibaly MO, Jones CB, Sietsema DL, et al. Results and complications of 90 consecutive cuboid fractures. Paper presented at: AOFAS 25th Annual Summer Meeting 2009; Vancouver, British Columbia, Canada.
  3. Khatri Chhetri KM, Acharya P, Rokaya Chhetri DR. Combined fracture dislocation of the navicular bone along with cuboid, cuneiform and longitudinal split fracture of the lateral malleolus: a rare combination of fractures. Chin J Traumatol 2014; 17:358.
  4. Schildhauer TA, Coulibaly MO, Hoffman MF. Fractures and dislocations of the midfoot and forefoot. In: Rockwood and Green's Fractures in Adults, 8th ed, Bucholz RW, Heckman JD, McQueen MM (Eds), Lippincott Williams & Wilkins, Philadelphia 2015. p.2690.
  5. Court-Brown CM, Caesar B. Epidemiology of adult fractures: A review. Injury 2006; 37:691.
  6. Guler F, Baz AB, Turan A, et al. Isolated medial cuneiform fractures: report of two cases and review of the literature. Foot Ankle Spec 2011; 4:306.
  7. Taylor SF, Heidenreich D. Isolated medial cuneiform fracture: a special forces soldier with a rare injury. South Med J 2008; 101:848.
  8. Harris GF. Analysis of ankle and subtalar motion during human locomotion. In: The Joints of the Ankle, Inman VT (Ed), Williams & Wilkins, Baltimore 1976. p.75.
  9. Kraus JC, McKeon KE, Johnson JE, et al. Intraosseous and extraosseous blood supply to the medial cuneiform: implications for dorsal opening wedge plantarflexion osteotomy. Foot Ankle Int 2014; 35:394.
  10. Fallat L, Grimm DJ, Saracco JA. Sprained ankle syndrome: prevalence and analysis of 639 acute injuries. J Foot Ankle Surg 1998; 37:280.
  11. HERMEL MB, GERSHON-COHEN J. The nutcracker fracture of the cuboid by indirect violence. Radiology 1953; 60:850.
  12. Carsen S, Quinn BJ, Beck E, et al. "Nutcracker Fracture" in a Ballet Dancer Performing in The Nutcracker. J Dance Med Sci 2015; 19:124.
  13. Ceroni D, De Rosa V, De Coulon G, Kaelin A. Cuboid nutcracker fracture due to horseback riding in children: case series and review of the literature. J Pediatr Orthop 2007; 27:557.
  14. Hagino T, Ochiai S, Watanabe Y, et al. A case of cuboid bone stress fracture in a senior high school rugby athlete. Asia-Pacific Journal of Sports Medicine, Arthroscopy, Rehabilitation and Technology 2014; 1:132.
  15. Yu SM, Dardani M, Yu JS. MRI of isolated cuboid stress fractures in adults. AJR Am J Roentgenol 2013; 201:1325.
  16. Chen JB. Cuboid stress fracture. A case report. J Am Podiatr Med Assoc 1993; 83:153.
  17. Franco M, Albano L, Kacso I, et al. An uncommon cause of foot pain: the cuboid insufficiency stress fracture. Joint Bone Spine 2005; 72:76.
  18. Welck MJ, Hayes T, Pastides P, et al. Stress fractures of the foot and ankle. Injury 2015.
  19. Bui-Mansfield LT, Thomas WR. Magnetic resonance imaging of stress injury of the cuneiform bones in patients with plantar fasciitis. J Comput Assist Tomogr 2009; 33:593.
  20. Borrelli J Jr, De S, VanPelt M. Fracture of the cuboid. J Am Acad Orthop Surg 2012; 20:472.
  21. Miller TT, Pavlov H, Gupta M, et al. Isolated injury of the cuboid bone. Emerg Radiol 2002; 9:272.
  22. Pinney SJ, Sangeorzan BJ. Fractures of the tarsal bones. Orthop Clin North Am 2001; 32:21.
  23. Fenton P, Al-Nammari S, Blundell C, Davies M. The patterns of injury and management of cuboid fractures: a retrospective case series. Bone Joint J 2016; 98-B:1003.
  24. Cheng Y, Yang H, Sun Z, et al. A rare midfoot injury pattern: navicular-cuneiform and calcaneal-cuboid fracture-dislocation. J Int Med Res 2012; 40:824.
  25. Eiff MP, Hatch RL. Fracture Management for Primary Care, 3rd ed, WB Saunders, Philadelphia 2011. p.276.